Efficacy and safety of azvudine in patients with COVID-19: A systematic review and meta-analysis

Chen et al., Heliyon, doi:10.1016/j.heliyon.2023.e20153, Sep 2023
Azvudine for COVID-19
48th treatment shown to reduce risk in January 2023, now with p = 0.000000017 from 39 studies.
No treatment is 100% effective. Protocols combine treatments.
6,400+ studies for 210+ treatments. c19early.org
Systematic review and meta analysis of 5 RCTs showing improved clinical recovery and faster viral clearance with azvudine treatment.
Liver injury. Studies show significantly increased risk of liver injury1,2.
5 meta-analyses show significant improvements with azvudine for mortality3-7, mechanical ventilation3, improvement3, progression7, and viral clearance3,5,6.
Currently there are 39 azvudine for COVID-19 studies, showing 30% lower mortality [20‑39%], 18% lower ventilation [-10‑39%], 21% lower ICU admission [5‑34%], and 10% lower hospitalization [0‑19%].
Chen et al., 30 Sep 2023, peer-reviewed, 2 authors. Contact: tianfangyuan0608@163.com.
Efficacy and safety of azvudine in patients with COVID-19: A systematic review and meta-analysis
Zhaoyan Chen, Fangyuan Tian
Heliyon, doi:10.1016/j.heliyon.2023.e20153
Introduction: Azivudine has undergone a few randomized controlled trials (RCTs) as of late. This study aimed to assess the COVID-19 treatment with azvudine's efficacy and safety. Methods: Through January 20, 2023, systematic searches of PubMed, Embase, ClinicalTrials.gov, International Clinical Trials Registry Platform (ICTRP), Cochrane Central Register of Controlled Trials (CENTRAL), and MedRxiv were conducted to find the RCTs. The included studies' bias risk was evaluated using the Cochrane Handbook for Systematic Reviews of Interventions. Metaanalysis was performed using Revman 5.4 (PROSPERO Code: CRD42023395022). Results: A total of five RCTs with 1142 COVID-19 patients, 575 of whom received azvudine, were included. Additionally, seven RCTs are currently being conducted. In terms of clinical improvement and PT-PCR (reverse transcription polymerase chain reaction) negativity, the azvudine group had a greater patient percentage than the usual treatment or placebo group. It also took less time for the PT-PCR to become negative. In comparison to the placebo or standard treatment groups, the frequency of adverse events was reduced in the azvudine group (risk ratio [RR] = 0.89, 95% confidence interval [CI]: 0.80 to 0.99) and major adverse events (RR = 0.63, 95% CI: 0.22 to 1.79) groups. Conclusions: Without the burden of side effects, azvudine can hasten the clinical symptoms of COVID-19 patients and PT-PCR negative. It will take more extensive research to confirm these conclusions.
Author contribution statement All authors listed have significantly contributed to the development and the writing of this article. Ethics statement Not required. Declaration of competing interest The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.
References
Bowe, Xie, Al-Aly, Acute and postacute sequelae associated with SARS-CoV-2 reinfection, Nat. Med, doi:10.1038/s41591-022-02051-3
Burden, Long, Collaborators, Hanson, Abbafati et al., Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021, JAMA, doi:10.1001/jama.2022.18931
Cabral, Da Silva, De Souza, Serial Viral Load Analysis by Ddpcr to Evaluate Fnc Efficacy and Safety in the Treatment of Mild Cases of Covid-19, doi:10.21203/rs.3.rs-2273694/v1
Cabral, De Souza, Da Silva, Serial Viral Load Analysis by Ddpcr to Evaluate Fnc Efficacy and Safety in the Treatment of Moderate Cases of Covid-19, 21 November 2022, doi:10.21203/rs.3.rs-2273657/v1
Dejmek, Konkoľová, Eyer, Non-nucleotide RNA-dependent RNA polymerase inhibitor that blocks SARS-CoV-2 replication, Viruses, doi:10.3390/v13081585
Group, Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study, Lancet Respir. Med, doi:10.1016/S2213-2600(22)00127-8
Higgins, Altman, Gøtzsche, Cochrane bias methods group; Cochrane statistical methods group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials, BMJ, doi:10.1136/bmj.d5928
Huang, Li, Gu, Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study, Lancet Respir. Med, doi:10.1016/S2213-2600(22)00126-6
Ledford, Maxmen, African clinical trial denied access to key COVID drug Paxlovid, Nature, doi:10.1038/d41586-022-00919-5
Li, Clercq, Therapeutic options for the 2019 novel coronavirus (2019-nCoV), Nat. Rev. Drug Discov, doi:10.1038/d41573-020-00016-0
Liu, Liu, Zhang, Intestinal absorption mechanisms of 2'-deoxy-2'-β-fluoro-4'-azidocytidine, a cytidine analog for AIDS treatment, and its interaction with P-glycoprotein, multidrug resistance-associated protein 2 and breast cancer resistance protein, Eur. J. Pharmaceut. Sci, doi:10.1016/j.ejps.2017.05.009
Liu, Wang, Peng, Effects of the antiretroviral drug 2'-deoxy-2'-β-fluoro-4'-azidocytidine (FNC) on P-gp, MRP2 and BCRP expressions and functions, Pharmazie, doi:10.1691/ph.2018.8555
Mallapaty, COVID-19: how Omicron overtook Delta in three charts, Nature, doi:10.1038/d41586-022-00632-3
Ren, Luo, Yu, A randomized, open-label, controlled clinical trial of azvudine tablets in the treatment of mild and common COVID-19, a pilot study, Adv. Sci, doi:10.1002/advs.202001435
Reynolds, Pade, Gibbons, Immune boosting by B.1.1.529 (Omicron) depends on previous SARS-CoV-2 exposure, Science, doi:10.1126/science.abq1841
Schöley, Aburto, Kashnitsky, Life expectancy changes since COVID-19, Nat. Human Behav, doi:10.1038/s41562-022-01450-3
Tian, Chen, Feng, Nirmatrelvir-ritonavir compared with other antiviral drugs for the treatment of COVID-19 patients: a systematic review and metaanalysis, J. Med. Virol, doi:10.1002/jmv.28732
Tian, Feng, Chen, Efficacy and safety of molnupiravir treatment for COVID-19: a systematic review and meta-analysis of randomized controlled trials, Int. J. Antimicrob. Agents, doi:10.1016/j.ijantimicag.2023.106870
Tian, Yang, Chen, Safety and efficacy of COVID-19 vaccines in children and adolescents: a systematic review of randomized controlled trials, J. Med. Virol, doi:10.1002/jmv.27940
Who, Coronavirus disease COVID-19
Yang, Rao, Structural biology of SARS-CoV-2 and implications for therapeutic development, Nat. Rev. Microbiol, doi:10.1038/s41579-021-00630-8
Yu, Chang, Azvudine (FNC): a promising clinical candidate for COVID-19 treatment, Signal Transduct, Targeted Ther, doi:10.1038/s41392-020-00351-z
Zhang, Li, Wang, Azvudine is a thymus-homing anti-SARS-CoV-2 drug effective in treating COVID-19 patients, Signal Transduct, Targeted Ther, doi:10.1038/s41392-021-00835-6
DOI record: { "DOI": "10.1016/j.heliyon.2023.e20153", "ISSN": [ "2405-8440" ], "URL": "http://dx.doi.org/10.1016/j.heliyon.2023.e20153", "alternative-id": [ "S2405844023073619" ], "article-number": "e20153", "assertion": [ { "label": "This article is maintained by", "name": "publisher", "value": "Elsevier" }, { "label": "Article Title", "name": "articletitle", "value": "Efficacy and safety of azvudine in patients with COVID-19: A systematic review and meta-analysis" }, { "label": "Journal Title", "name": "journaltitle", "value": "Heliyon" }, { "label": "CrossRef DOI link to publisher maintained version", "name": "articlelink", "value": "https://doi.org/10.1016/j.heliyon.2023.e20153" }, { "label": "Content Type", "name": "content_type", "value": "article" }, { "label": "Copyright", "name": "copyright", "value": "© 2023 The Authors. Published by Elsevier Ltd." } ], "author": [ { "affiliation": [], "family": "Chen", "given": "Zhaoyan", "sequence": "first" }, { "ORCID": "http://orcid.org/0000-0002-5187-0386", "affiliation": [], "authenticated-orcid": false, "family": "Tian", "given": "Fangyuan", "sequence": "additional" } ], "container-title": "Heliyon", "container-title-short": "Heliyon", "content-domain": { "crossmark-restriction": true, "domain": [ "cell.com", "elsevier.com", "sciencedirect.com" ] }, "created": { "date-parts": [ [ 2023, 9, 15 ] ], "date-time": "2023-09-15T10:15:27Z", "timestamp": 1694772927000 }, "deposited": { "date-parts": [ [ 2023, 11, 27 ] ], "date-time": "2023-11-27T20:52:22Z", "timestamp": 1701118342000 }, "indexed": { "date-parts": [ [ 2023, 11, 28 ] ], "date-time": "2023-11-28T00:40:18Z", "timestamp": 1701132018029 }, "is-referenced-by-count": 0, "issue": "9", "issued": { "date-parts": [ [ 2023, 9 ] ] }, "journal-issue": { "issue": "9", "published-print": { "date-parts": [ [ 2023, 9 ] ] } }, "language": "en", "license": [ { "URL": "https://www.elsevier.com/tdm/userlicense/1.0/", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2023, 9, 1 ] ], "date-time": "2023-09-01T00:00:00Z", "timestamp": 1693526400000 } }, { "URL": "http://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 12, "start": { "date-parts": [ [ 2023, 9, 13 ] ], "date-time": "2023-09-13T00:00:00Z", "timestamp": 1694563200000 } } ], "link": [ { "URL": "https://api.elsevier.com/content/article/PII:S2405844023073619?httpAccept=text/xml", "content-type": "text/xml", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://api.elsevier.com/content/article/PII:S2405844023073619?httpAccept=text/plain", "content-type": "text/plain", "content-version": "vor", "intended-application": "text-mining" } ], "member": "78", "original-title": [], "page": "e20153", "prefix": "10.1016", "published": { "date-parts": [ [ 2023, 9 ] ] }, "published-print": { "date-parts": [ [ 2023, 9 ] ] }, "publisher": "Elsevier BV", "reference": [ { "DOI": "10.1038/s41562-022-01450-3", "article-title": "Life expectancy changes since COVID-19", "author": "Schöley", "doi-asserted-by": "crossref", "first-page": "1649", "issue": "12", "journal-title": "Nat. Human Behav.", "key": "10.1016/j.heliyon.2023.e20153_bib1", "volume": "6", "year": "2022" }, { "DOI": "10.1002/jmv.27940", "article-title": "Safety and efficacy of COVID-19 vaccines in children and adolescents: a systematic review of randomized controlled trials", "author": "Tian", "doi-asserted-by": "crossref", "first-page": "4644", "issue": "10", "journal-title": "J. Med. Virol.", "key": "10.1016/j.heliyon.2023.e20153_bib2", "volume": "94", "year": "2022" }, { "key": "10.1016/j.heliyon.2023.e20153_bib3", "unstructured": "WHO. Coronavirus disease COVID-19. https://www.who.int/emergencies/diseases/novel-coronavirus-2019. Accessed January 12, 2023.." }, { "article-title": "COVID-19: how Omicron overtook Delta in three charts", "author": "Mallapaty", "journal-title": "Nature", "key": "10.1016/j.heliyon.2023.e20153_bib4", "year": "2022" }, { "DOI": "10.1126/science.abq1841", "article-title": "Immune boosting by B.1.1.529 (Omicron) depends on previous SARS-CoV-2 exposure", "author": "Reynolds", "doi-asserted-by": "crossref", "issue": "6603", "journal-title": "Science", "key": "10.1016/j.heliyon.2023.e20153_bib5", "volume": "377", "year": "2022" }, { "DOI": "10.1016/S2213-2600(22)00127-8", "article-title": "Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study", "doi-asserted-by": "crossref", "first-page": "761", "issue": "8", "journal-title": "Lancet Respir. Med.", "key": "10.1016/j.heliyon.2023.e20153_bib6", "volume": "10", "year": "2022" }, { "DOI": "10.1016/S2213-2600(22)00126-6", "article-title": "Health outcomes in people 2 years after surviving hospitalisation with COVID-19: a longitudinal cohort study", "author": "Huang", "doi-asserted-by": "crossref", "first-page": "863", "issue": "9", "journal-title": "Lancet Respir. Med.", "key": "10.1016/j.heliyon.2023.e20153_bib7", "volume": "10", "year": "2022" }, { "DOI": "10.1038/s41591-022-02051-3", "article-title": "Acute and postacute sequelae associated with SARS-CoV-2 reinfection", "author": "Bowe", "doi-asserted-by": "crossref", "first-page": "2398", "issue": "11", "journal-title": "Nat. Med.", "key": "10.1016/j.heliyon.2023.e20153_bib8", "volume": "28", "year": "2022" }, { "DOI": "10.1001/jama.2022.18931", "article-title": "Estimated global proportions of individuals with persistent fatigue, cognitive, and respiratory symptom clusters following symptomatic COVID-19 in 2020 and 2021", "author": "Wulf Hanson", "doi-asserted-by": "crossref", "first-page": "1604", "issue": "16", "journal-title": "JAMA", "key": "10.1016/j.heliyon.2023.e20153_bib9", "volume": "328", "year": "2022" }, { "DOI": "10.1016/j.ijantimicag.2023.106870", "article-title": "Efficacy and safety of molnupiravir treatment for COVID-19: a systematic review and meta-analysis of randomized controlled trials", "author": "Tian", "doi-asserted-by": "crossref", "issue": "2", "journal-title": "Int. J. Antimicrob. Agents", "key": "10.1016/j.heliyon.2023.e20153_bib10", "volume": "62", "year": "2023" }, { "DOI": "10.1002/jmv.28732", "article-title": "Nirmatrelvir-ritonavir compared with other antiviral drugs for the treatment of COVID-19 patients: a systematic review and meta-analysis", "author": "Tian", "doi-asserted-by": "crossref", "issue": "4", "journal-title": "J. Med. Virol.", "key": "10.1016/j.heliyon.2023.e20153_bib11", "volume": "95", "year": "2023" }, { "DOI": "10.1038/d41573-020-00016-0", "article-title": "Therapeutic options for the 2019 novel coronavirus (2019-nCoV)", "author": "Li", "doi-asserted-by": "crossref", "first-page": "149", "issue": "3", "journal-title": "Nat. Rev. Drug Discov.", "key": "10.1016/j.heliyon.2023.e20153_bib12", "volume": "19", "year": "2020" }, { "DOI": "10.3390/v13081585", "article-title": "Non-nucleotide RNA-dependent RNA polymerase inhibitor that blocks SARS-CoV-2 replication", "author": "Dejmek", "doi-asserted-by": "crossref", "first-page": "1585", "issue": "8", "journal-title": "Viruses", "key": "10.1016/j.heliyon.2023.e20153_bib13", "volume": "13", "year": "2021" }, { "DOI": "10.1038/s41579-021-00630-8", "article-title": "Structural biology of SARS-CoV-2 and implications for therapeutic development", "author": "Yang", "doi-asserted-by": "crossref", "first-page": "685", "issue": "11", "journal-title": "Nat. Rev. Microbiol.", "key": "10.1016/j.heliyon.2023.e20153_bib14", "volume": "19", "year": "2021" }, { "DOI": "10.1038/s41392-020-00351-z", "article-title": "Azvudine (FNC): a promising clinical candidate for COVID-19 treatment", "author": "Yu", "doi-asserted-by": "crossref", "first-page": "236", "issue": "1", "journal-title": "Signal Transduct. Targeted Ther.", "key": "10.1016/j.heliyon.2023.e20153_bib15", "volume": "5", "year": "2020" }, { "DOI": "10.1136/bmj.d5928", "article-title": "Cochrane bias methods group; Cochrane statistical methods group. The Cochrane Collaboration's tool for assessing risk of bias in randomised trials", "author": "Higgins", "doi-asserted-by": "crossref", "first-page": "d5928", "journal-title": "BMJ", "key": "10.1016/j.heliyon.2023.e20153_bib16", "volume": "343", "year": "2011" }, { "DOI": "10.21203/rs.3.rs-2273657/v1", "doi-asserted-by": "crossref", "key": "10.1016/j.heliyon.2023.e20153_bib17", "unstructured": "Paula Cabral, Sávio de Souza, Renato da Silva, et al. Serial Viral Load Analysis by Ddpcr to Evaluate Fnc Efficacy and Safety in the Treatment of Moderate Cases of Covid-19, 21 November 2022, PREPRINT (Version 1) available at Research Square. https://doi.org/10.21203/rs.3.rs-2273657/v1, ." }, { "author": "Cabral", "key": "10.1016/j.heliyon.2023.e20153_bib18", "series-title": "Serial Viral Load Analysis by Ddpcr to Evaluate Fnc Efficacy and Safety in the Treatment of Mild Cases of Covid-19, 21 November", "year": "2022" }, { "DOI": "10.1002/advs.202001435", "article-title": "A randomized, open-label, controlled clinical trial of azvudine tablets in the treatment of mild and common COVID-19, a pilot study", "author": "Ren", "doi-asserted-by": "crossref", "issue": "19", "journal-title": "Adv. Sci.", "key": "10.1016/j.heliyon.2023.e20153_bib19", "volume": "7", "year": "2020" }, { "key": "10.1016/j.heliyon.2023.e20153_bib20", "unstructured": "https://www1.hkexnews.hk/app/sehk/2022/104646/documents/sehk22080402059.pdf." }, { "DOI": "10.1038/d41586-022-00919-5", "article-title": "African clinical trial denied access to key COVID drug Paxlovid", "author": "Ledford", "doi-asserted-by": "crossref", "first-page": "412", "issue": "7906", "journal-title": "Nature", "key": "10.1016/j.heliyon.2023.e20153_bib21", "volume": "604", "year": "2022" }, { "DOI": "10.1038/s41392-021-00835-6", "article-title": "Azvudine is a thymus-homing anti-SARS-CoV-2 drug effective in treating COVID-19 patients", "author": "Zhang", "doi-asserted-by": "crossref", "first-page": "414", "issue": "1", "journal-title": "Signal Transduct. Targeted Ther.", "key": "10.1016/j.heliyon.2023.e20153_bib22", "volume": "6", "year": "2021" }, { "article-title": "Effects of the antiretroviral drug 2'-deoxy-2'-β-fluoro-4'-azidocytidine (FNC) on P-gp, MRP2 and BCRP expressions and functions", "author": "Liu", "first-page": "503", "issue": "9", "journal-title": "Pharmazie", "key": "10.1016/j.heliyon.2023.e20153_bib23", "volume": "73", "year": "2018" }, { "DOI": "10.1016/j.ejps.2017.05.009", "article-title": "Intestinal absorption mechanisms of 2'-deoxy-2'-β-fluoro-4'-azidocytidine, a cytidine analog for AIDS treatment, and its interaction with P-glycoprotein, multidrug resistance-associated protein 2 and breast cancer resistance protein", "author": "Liu", "doi-asserted-by": "crossref", "first-page": "150", "journal-title": "Eur. J. Pharmaceut. Sci.", "key": "10.1016/j.heliyon.2023.e20153_bib24", "volume": "105", "year": "2017" } ], "reference-count": 24, "references-count": 24, "relation": {}, "resource": { "primary": { "URL": "https://linkinghub.elsevier.com/retrieve/pii/S2405844023073619" } }, "score": 1, "short-title": [], "source": "Crossref", "subject": [ "Multidisciplinary" ], "subtitle": [], "title": "Efficacy and safety of azvudine in patients with COVID-19: A systematic review and meta-analysis", "type": "journal-article", "update-policy": "http://dx.doi.org/10.1016/elsevier_cm_policy", "volume": "9" }
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ datapoints from thousands of papers. Community updates help ensure high accuracy. Treatments and other interventions are complementary. All practical, effective, and safe means should be used based on risk/benefit analysis. No treatment or intervention is 100% available and effective for all current and future variants. We do not provide medical advice. Before taking any medication, consult a qualified physician who can provide personalized advice and details of risks and benefits based on your medical history and situation. IMA and WCH provide treatment protocols.
  or use drag and drop   
Submit