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Baloxavir marboxil (baloxavir) was FDA approved in 2018 for the treatment of seasonal influenza A and B. The drug acts through inhibition of a cap-dependent endonuclease, thereby interfering with viral mRNA synthesis. A single dose is as effective in shortening duration of illness as the recommended 5-day courses of twice-daily neuraminidase inhibitors. However, baloxavir-resistant viruses have emerged that are 10 to 420 times less susceptible than wild-type viruses. The variant viruses had amino acid substitutions in the polymerase acidic protein (PA).
In a multicenter, double-blind, randomized, placebo-controlled study, researchers in Japan evaluated the protective effect of a single dose of baloxavir versus placebo in 752 household contac…