Immunological profile and antiviral therapy of influenza with account for virus serotype

The clinical efficacy of antiviral therapy (AVT) in moderate influenza, its dependence on virus serotype, and the contribution of interferon-inducer augmentation (kagocel) to the baseline regimen remain under active discussion. Aim. To characterise the immunological profile and clinical–laboratory efficacy of four AVT regimens in patients with moderate mono-influenza according to virus serotype and to evaluate the effect of Kagocel augmentation. 120 patients with laboratory-confirmed moderate influenza (30 per group: seasonal A(H1N1), A(H1N1)pdm09, A(H3N2), B) were examined in Vladivostok, 2016–2020. The control group comprised 31 apparently healthy donors. Four AVT regimens per serotype were used: umifenovir, umifenovir + kagocel, oseltamivir, oseltamivir + kagocel. Twenty-two immune, acute-phase, haematological and composite parameters (NLR, PLR, MLR, LMR, SII, SIRI) were assessed at admission (V1) and discharge (V2). Results. Pronounced systemic hypercytokinaemia was documented (IL-17, IL-18, TNF-α, IFN-α, CRP; all q<10-¹³); the highest IL-10 and IFN-γ response was observed in A(H1N1)pdm09, the weakest – in A(H3N2). All regimens produced comparable decline of cytokines and inflammatory indices. The maximal clinical effect of kagocel augmentation was seen in A(H1N1)pdm09 and influenza B. All AVT regimens produced comparable suppression of systemic inflammation. The augmentation with Kagocel demonstrated a serotype-specific clinical advantage without an additional cytokine-modulating effect. The oseltamivir + kagocel regimen provides the best integrated clinical profile.

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