Sensible Medicine This Fortnight in Medicine XVIII
Jan 28, 2026
They debate a new flu antiviral, covering trial results, timing of treatment, household transmission, costs, and comparisons with older drugs. They dig into a heart failure trial about rapid medication up-titration, questioning follow-up intensity, patient selection, and real-world applicability. The conversation centers on tradeoffs between pragmatic trials and individualized clinical care.
AI Snips
Chapters
Transcript
Episode notes
Baloxavir Mirrors Tamiflu On Symptoms
- Baloxavir (Xofluza) shortens influenza symptoms by about 1–2 days, similar to oseltamivir.
- Surrogate improvements in viral load didn’t translate into clear additional clinical benefit in that trial.
Viral Load Falls Don’t Guarantee Big Gains
- Faster viral-load decline with baloxavir didn’t yield larger clinical gains versus oseltamivir.
- Household transmission fell modestly (13.4% to 9.5%) in a later placebo-controlled study.
Start Antivirals Within 48 Hours
- Give oseltamivir or baloxavir within 48 hours of symptom onset to get meaningful benefit.
- Beyond 48 hours, trials show little to no symptomatic improvement.