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

Chen et al., Scientific Reports, doi:10.1038/s41598-024-53862-y
Feb 2024  
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Retrospective 157 hospitalized mild-to-moderate COVID-19 patients showing no significant differences between azvudine, molnupiravir, and paxlovid for time to viral clearance and length of hospitalization.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid1. Retrospective studies that do not exclude contraindicated patients may significantly overestimate efficacy.
Black box warning. The FDA notes that "severe, life-threatening, and/or fatal adverse reactions due to drug interactions have been reported in patients treated with paxlovid"2.
Resistant variants are likely3,4.
Study covers azvudine, paxlovid, and molnupiravir.
Chen et al., 9 Feb 2024, retrospective, China, peer-reviewed, mean age 41.1, 5 authors, study period March 2022 - November 2022. Contact: zhouzhiguo1217@163.com.
This PaperPaxlovidAll
Comparison of azvudine, molnupiravir, and nirmatrelvir/ritonavir in adult patients with mild-to-moderate COVID-19: a retrospective cohort study
Mei-Ping Chen, Di-Xuan Jiang, Jia-Xi Rang, Hai-Bo Zhuo, Zhi-Guo Zhou
Scientific Reports, doi:10.1038/s41598-024-53862-y
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, P = 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, P = 0.50], or hospital stay [median, 11 (95% CI 11-13) vs. 13 (95% CI 12-14) vs. 12 (95% CI 10-14) days, P = 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 (P = 0.858), 34.8%/21.5%/32.0% at day 7 (P = 0.226), 66.7%/52.3%/60.0% at 10 days (P = 0.246), and 86.4%/86.2%/80.0% at day 14 (P = 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.
Author contributions Z.G.Z. and M.P.C. conceived and coordinated the study, designed, performed and analyzed the experiments, wrote the paper. D.X.J., J.X.R. and H.B.Z. carried out the data collection, data analysis, and revised the paper. All authors reviewed the results and approved the final version of the manuscript. Competing interests The authors declare no competing interests.
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Editorial: Rebound COVID-19 and cessation of antiviral ' 'treatment for SARS-CoV-2 with paxlovid and molnupiravir. Med. Sci. ' 'Monit. 28, e938532 (2022).', 'journal-title': 'Med. Sci. Monit.'}, { 'key': '53862_CR35', 'doi-asserted-by': 'publisher', 'first-page': '1047', 'DOI': '10.1056/NEJMc2205944', 'volume': '387', 'author': 'AS Anderson', 'year': '2022', 'unstructured': 'Anderson, A. S., Caubel, P., Rusnak, J. M. & Investigators, E.-H.T. ' 'Nirmatrelvir–ritonavir and viral load rebound in Covid-19. N. Engl. J. ' 'Med. 387, 1047–1049 (2022).', 'journal-title': 'N. Engl. J. Med.'}, { 'key': '53862_CR36', 'doi-asserted-by': 'publisher', 'first-page': '1045', 'DOI': '10.1056/NEJMc2206449', 'volume': '387', 'author': 'ME Charness', 'year': '2022', 'unstructured': 'Charness, M. E. et al. Rebound of SARS-CoV-2 infection after ' 'nirmatrelvir-ritonavir treatment. N. Engl. J. Med. 387, 1045–1047 ' '(2022).', 'journal-title': 'N. Engl. J. Med.'}, { 'key': '53862_CR37', 'doi-asserted-by': 'publisher', 'first-page': '2380', 'DOI': '10.1001/jama.2022.9925', 'volume': '327', 'author': 'R Rubin', 'year': '2022', 'unstructured': 'Rubin, R. From positive to negative to positive again-the mystery of why ' 'COVID-19 rebounds in some patients who take paxlovid. JAMA 327, ' '2380–2382 (2022).', 'journal-title': 'JAMA'}, { 'key': '53862_CR38', 'doi-asserted-by': 'publisher', 'first-page': '276', 'DOI': '10.1038/s41392-020-00407-0', 'volume': '5', 'author': 'ZG Zhou', 'year': '2020', 'unstructured': 'Zhou, Z. G. et al. Low-dose corticosteroid combined with immunoglobulin ' 'reverses deterioration in severe cases with COVID-19. Signal Transduct. ' 'Target. Ther. 5, 276 (2020).', 'journal-title': 'Signal Transduct. Target. Ther.'}], 'container-title': 'Scientific Reports', 'original-title': [], 'language': 'en', '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'}], 'deposited': { 'date-parts': [[2024, 2, 9]], 'date-time': '2024-02-09T08:06:08Z', 'timestamp': 1707465968000}, 'score': 1, 'resource': {'primary': {'URL': 'https://www.nature.com/articles/s41598-024-53862-y'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2024, 2, 9]]}, 'references-count': 38, 'journal-issue': {'issue': '1', 'published-online': {'date-parts': [[2024, 12]]}}, 'alternative-id': ['53862'], 'URL': 'http://dx.doi.org/10.1038/s41598-024-53862-y', 'relation': {}, 'ISSN': ['2045-2322'], 'subject': ['Multidisciplinary'], 'container-title-short': 'Sci Rep', 'published': {'date-parts': [[2024, 2, 9]]}, 'assertion': [ { 'value': '21 July 2023', 'order': 1, 'name': 'received', 'label': 'Received', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '6 February 2024', 'order': 2, 'name': 'accepted', 'label': 'Accepted', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': '9 February 2024', 'order': 3, 'name': 'first_online', 'label': 'First Online', 'group': {'name': 'ArticleHistory', 'label': 'Article History'}}, { 'value': 'The authors declare no competing interests.', 'order': 1, 'name': 'Ethics', 'group': {'name': 'EthicsHeading', 'label': 'Competing interests'}}], 'article-number': '3318'}
Please send us corrections, updates, or comments. c19early involves the extraction of 100,000+ 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. FLCCC and WCH provide treatment protocols.
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