Beyond Tamiflu: Why a New Antiviral Could Change How We Fight the Flu
This flu season isn’t just bad – it’s historically awful. With a variant largely mismatched to the vaccine and hospitalizations breaking records, the usual advice to “get your shot” feels insufficient. But there’s a second line of defense often overlooked: antiviral drugs. And increasingly, experts are saying it’s time we started using them, especially a newer option called Xofluza that’s proving to be significantly better than the decades-old standard, Tamiflu.
The Subclade K Challenge and a Flu Season Unlike Any Other
The culprit behind this year’s surge is subclade K, a mutated version of the H3N2 virus that evolved too quickly for inclusion in the 2023-24 vaccine. While the shot still offers some protection, its effectiveness is questionable. Epidemiologist Arnold Monto of the University of Michigan, a veteran of 60 flu seasons, described the current spread as “a straight line, nearly everywhere all at once” – an unusually synchronized outbreak. Though cases appear to be leveling off, the coming weeks still promise significant illness.
Antivirals: A Dramatically Underutilized Tool
Despite their potential, antivirals remain woefully underused. “We are dramatically and drastically underutilizing influenza antivirals,” says Dr. Janet Englund, a pediatric infectious disease specialist at the University of Washington. Consider this: an estimated 40 million Americans likely contracted the flu this winter, yet only around 1.2 million Tamiflu prescriptions were filled. Xofluza fares even worse, accounting for a mere 1-10% of Tamiflu prescriptions. This represents a massive gap in preventative and treatment strategies.
Xofluza vs. Tamiflu: A Clear Winner?
Both Tamiflu and Xofluza can shorten the duration of flu symptoms by about a day, but Xofluza offers several key advantages. First, convenience. Xofluza is a single-dose treatment, compared to Tamiflu’s five-day, twice-daily regimen. This is a significant benefit, especially for children or those already feeling unwell. Second, Xofluza tends to cause fewer gastrointestinal side effects like nausea and vomiting.
Reducing Contagion and Preventing Complications
Beyond symptom relief, Xofluza demonstrably reduces contagiousness. It rapidly lowers the viral load in patients, potentially because it targets viral replication directly, while Tamiflu primarily prevents the release of already-replicated viruses. A study led by Dr. Monto showed Xofluza cut household transmission by nearly one-third compared to a placebo. Furthermore, studies indicate Xofluza is linked to fewer emergency room visits and hospitalizations, particularly crucial for high-risk individuals like those over 65. As Dr. Frederick Hayden of the University of Virginia notes, Xofluza should be the preferred choice for these vulnerable populations.
Influenza B Coverage: Another Xofluza Advantage
While less relevant this season due to the dominance of influenza A, Xofluza is notably more effective against influenza B strains, against which Tamiflu’s efficacy wanes. This broader coverage provides an additional layer of protection.
The Barriers to Access and a Path Forward
Despite its benefits, Xofluza remains less popular due to cost and accessibility. Tamiflu, available as a generic, can cost under $30 without insurance, while Xofluza typically runs $150-$200. This price difference, coupled with lower demand, means pharmacies are less likely to stock it. However, the manufacturer of Xofluza has recently launched a direct-to-customer program offering the drug for $50 with same-day delivery, a significant step towards increased access. Learn more about the Xofluza direct-to-customer program here.
The Future of Flu Treatment: Rapid Testing and Prophylactic Use
Wider adoption of antivirals hinges on improved testing. Both drugs are most effective within the first 48 hours of symptom onset. The rise of at-home rapid tests, popularized during the COVID-19 pandemic, offers a solution, allowing for quicker diagnosis and treatment initiation. However, the cost of these tests – around $20 in the US, compared to just a few dollars in Europe – remains a barrier. Japan offers a compelling model, with routine rapid testing and antiviral access largely covered by their public healthcare system.
Looking ahead, proactive use of antivirals – prescribing them prophylactically to high-risk individuals exposed to the flu – could significantly reduce severe illness and death. Studies show both Xofluza and Tamiflu can cut the risk of infection by up to 80% when taken preventatively. Ultimately, as Dr. Cameron Wolfe of Duke University emphasizes, “the best drug is the one you can get.” But with Xofluza’s advantages becoming increasingly clear, it’s time to push for wider access and awareness of this potentially game-changing antiviral.
What steps can healthcare systems take to improve antiviral access and utilization? Share your thoughts in the comments below!
