values observed for the RdRp inhibitor favipiravir. Niclosamide treatment plus either baloxavir marboxil or favipiravir resulted in additive or near-additive interactions, as indicated by synergy scores of ±10. Importantly, niclosamide retained antiviral activity against HPAI A(H5Nx) viruses bearing resistance-associated amino acid substitutions (i.e., PA-I38T, baloxavir resistance and PB1-K229R, favipiravir resistance), consistent with its host-directed mechanism of action. Although there are barriers to be overcome such as a narrow therapeutic window, largely attributable to its poor bioavailability and some cytotoxicity, our findings suggest niclosamide has potential as a host-targeting therapeutic option against emerging zoonotic influenza viruses, particularly in settings involving antiviral-resistant escape mutants.
Chiba et al. (2026) studied this question.