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VV116 versus Nirmatrelvir–Ritonavir for Oral Treatment of Covid-19

Cao et al., New England Journal of Medicine, doi:10.1056/NEJMoa2208822, NCT05341609
Dec 2022  
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RCT 771 hospitalized patients with mild-to-moderate COVID-19 and high risk of progression showing non-inferior time to sustained clinical recovery with 5 days of VV116 compared to 5 days of paxlovid. No deaths or progression to severe disease occurred in either group. VV116 had a lower incidence of adverse events than paxlovid.
Cao et al., 28 Dec 2022, Single Blind Randomized Controlled Trial, China, peer-reviewed, 22 authors, study period 4 April, 2022 - 2 May, 2022, trial NCT05341609 (history). Contact:
This PaperDeuremidevirAll
VV116 versus Nirmatrelvir–Ritonavir for Oral Treatment of Covid-19
Zhujun Cao, Weiyi Gao, Hong Bao, Haiyan Feng, Shuya Mei, Peizhan Chen, Yueqiu Gao, Zhilei Cui, Qin Zhang, Xianmin Meng, Honglian Gui, Weijing Wang, Yimei Jiang, Zijia Song, Yiqing Shi, Jing Sun, Yifei Zhang, Qing Xie, Yiping Xu, Guang Ning, Yuan Gao, Ren Zhao
New England Journal of Medicine, doi:10.1056/nejmoa2208822
BACKGROUND Nirmatrelvir-ritonavir has been authorized for emergency use by many countries for the treatment of coronavirus disease 2019 (Covid-19). However, the supply falls short of the global demand, which creates a need for more options. VV116 is an oral antiviral agent with potent activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). METHODS We conducted a phase 3, noninferiority, observer-blinded, randomized trial during the outbreak caused by the B.1.1.529 (omicron) variant of SARS-CoV-2. Symptomatic adults with mild-to-moderate Covid-19 with a high risk of progression were assigned to receive a 5-day course of either VV116 or nirmatrelvir-ritonavir. The primary end point was the time to sustained clinical recovery through day 28. Sustained clinical recovery was defined as the alleviation of all Covid-19-related target symptoms to a total score of 0 or 1 for the sum of each symptom (on a scale from 0 to 3, with higher scores indicating greater severity; total scores on the 11item scale range from 0 to 33) for 2 consecutive days. A lower boundary of the two-sided 95% confidence interval for the hazard ratio of more than 0.8 was considered to indicate noninferiority (with a hazard ratio of >1 indicating a shorter time to sustained clinical recovery with VV116 than with nirmatrelvir-ritonavir). RESULTS A total of 822 participants underwent randomization, and 771 received VV116 (384 participants) or nirmatrelvir-ritonavir (387 participants). The noninferiority of VV116 to nirmatrelvir-ritonavir with respect to the time to sustained clinical recovery was established in the primary analysis (hazard ratio, 1.17; 95% confidence interval [CI], 1.01 to 1.35) and was maintained in the final analysis (median, 4 days with VV116 and 5 days with nirmatrelvir-ritonavir; hazard ratio, 1.17; 95% CI, 1.02 to 1.36). In the final analysis, the time to sustained symptom resolution (score of 0 for each of the 11 Covid-19-related target symptoms for 2 consecutive days) and to a first negative SARS-CoV-2 test did not differ substantially between the two groups. No participants in either group had died or had had progression to severe Covid-19 by day 28. The incidence of adverse events was lower in the VV116 group than in the nirmatrelvir-ritonavir group (67.4% vs. 77.3%). CONCLUSIONS Among adults with mild-to-moderate Covid-19 who were at risk for progression, VV116 was noninferior to nirmatrelvir-ritonavir with respect to the time to sustained clinical recovery, with fewer safety concerns.
Appendix The authors' full names and academic degrees are as follows: Zhujun Cao
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