Comparison of azvudine, molnupiravir, and nirmatrelvir/ritonavir in adult patients with mild-to-moderate COVID-19: a retrospective cohort study

DOI record: { "DOI": "10.1038/s41598-024-53862-y", "ISSN": [ "2045-2322" ], "URL": "http://dx.doi.org/10.1038/s41598-024-53862-y", "abstract": "<jats:title>Abstract</jats:title><jats:p>This study aimed to explore the effectiveness and safety of azvudine, nirmatrelvir/ritonavir, and molnupiravir in adult patients with mild-to-moderate COVID-19. This retrospective cohort study included patients with mild-to-moderate COVID-19 (asymptomatic, mild, and common types) at the First Hospital of Changsha (Hunan Province, China) between March and November 2022. Eligible patients were classified into the azvudine, nirmatrelvir/ritonavir, or molnupiravir groups according to the antiviral agents they received. The outcomes were the times to nucleic acid negative conversion (NANC). This study included 157 patients treated with azvudine (n = 66), molnupiravir (n = 66), or nirmatrelvir/ritonavir (n = 25). There were no statistically significant differences in the time from diagnosis to NANC among the azvudine, molnupiravir, and nirmatrelvir/ritonavir groups [median, 9 (95% CI 9–11) vs. 11 (95% CI 10–12) vs. 9 (95% CI 8–12) days, <jats:italic>P</jats:italic> = 0.15], time from administration to NANC [median, 9 (95% CI 8–10) vs. 10 (95% CI 9.48–11) vs. 8.708 (95% CI 7.51–11) days, <jats:italic>P</jats:italic> = 0.50], or hospital stay [median, 11 (95% CI 11–13) vs. 13 (95% CI 12–14) vs. 12 (95% CI 10–14) days, <jats:italic>P</jats:italic> = 0.14], even after adjustment for sex, age, COVID-19 type, comorbidities, Ct level, time from diagnosis to antiviral treatment, and number of symptoms. The cumulative NANC rates in the azvudine, molnupiravir, and nirmatrelvir/ritonavir groups were 15.2%/12.3%/16.0% at day 5 (<jats:italic>P</jats:italic> = 0.858), 34.8%/21.5%/32.0% at day 7 (<jats:italic>P</jats:italic> = 0.226), 66.7%/52.3%/60.0% at 10 days (<jats:italic>P</jats:italic> = 0.246), and 86.4%/86.2%/80.0% at day 14 (<jats:italic>P</jats:italic> = 0.721). No serious adverse events were reported. Azvudine may be comparable to nirmatrelvir/ritonavir and molnupiravir in adult patients with mild-to-moderate COVID-19 regarding time to NANC, hospital stay, and AEs.</jats:p>", "alternative-id": [ "53862" ], "article-number": "3318", "assertion": [ { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Received", "name": "received", "order": 1, "value": "21 July 2023" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "Accepted", "name": "accepted", "order": 2, "value": "6 February 2024" }, { "group": { "label": "Article History", "name": "ArticleHistory" }, "label": "First Online", "name": "first_online", "order": 3, "value": "9 February 2024" }, { "group": { "label": "Competing interests", "name": "EthicsHeading" }, "name": "Ethics", "order": 1, "value": "The authors declare no competing interests." } ], "author": [ { "affiliation": [], "family": "Chen", "given": "Mei-Ping", "sequence": "first" }, { "affiliation": [], "family": "Jiang", "given": "Di-Xuan", "sequence": "additional" }, { "affiliation": [], "family": "Rang", "given": "Jia-Xi", "sequence": "additional" }, { "affiliation": [], "family": "Zhuo", "given": "Hai-Bo", "sequence": "additional" }, { "affiliation": [], "family": "Zhou", "given": "Zhi-Guo", "sequence": "additional" } ], "container-title": "Scientific Reports", "container-title-short": "Sci Rep", "content-domain": { "crossmark-restriction": false, "domain": [ "link.springer.com" ] }, "created": { "date-parts": [ [ 2024, 2, 9 ] ], "date-time": "2024-02-09T08:03:22Z", "timestamp": 1707465802000 }, "deposited": { "date-parts": [ [ 2024, 2, 9 ] ], "date-time": "2024-02-09T08:06:08Z", "timestamp": 1707465968000 }, "funder": [ { "award": [ "2022SK2047", "2020SK3014" ], "name": "Key Research & Developmenta Program of Hunan Province" }, { "award": [ "kq2208448" ], "name": "Natural Science Foundation of Changsha city" } ], "indexed": { "date-parts": [ [ 2024, 2, 11 ] ], "date-time": "2024-02-11T12:15:44Z", "timestamp": 1707653744037 }, "is-referenced-by-count": 0, "issue": "1", "issued": { "date-parts": [ [ 2024, 2, 9 ] ] }, "journal-issue": { "issue": "1", "published-online": { "date-parts": [ [ 2024, 12 ] ] } }, "language": "en", "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "tdm", "delay-in-days": 0, "start": { "date-parts": [ [ 2024, 2, 9 ] ], "date-time": "2024-02-09T00:00:00Z", "timestamp": 1707436800000 } }, { "URL": "https://creativecommons.org/licenses/by/4.0", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2024, 2, 9 ] ], "date-time": "2024-02-09T00:00:00Z", "timestamp": 1707436800000 } } ], "link": [ { "URL": "https://www.nature.com/articles/s41598-024-53862-y.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.nature.com/articles/s41598-024-53862-y", "content-type": "text/html", "content-version": "vor", "intended-application": "text-mining" }, { "URL": "https://www.nature.com/articles/s41598-024-53862-y.pdf", "content-type": "application/pdf", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "297", "original-title": [], "prefix": "10.1038", "published": { "date-parts": [ [ 2024, 2, 9 ] ] }, "published-online": { "date-parts": [ [ 2024, 2, 9 ] ] }, "publisher": "Springer Science and Business Media LLC", "reference": [ { "DOI": "10.1001/jama.2020.12839", "author": "WJ Wiersinga", "doi-asserted-by": "publisher", "first-page": "782", "journal-title": "JAMA", "key": "53862_CR1", "unstructured": "Wiersinga, W. 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