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All-cause mortality in moderate and severe COVID-19 patients with myocardial injury receiving versus not receiving azvudine: a propensity score-matched analysis

Chen et al., Cardiology Plus, doi:10.1097/CP9.0000000000000049
Apr 2023  
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Mortality, in-hospital 6% Improvement Relative Risk Mortality, day 14 63% Azvudine for COVID-19  Chen et al.  LATE TREATMENT Is late treatment with azvudine beneficial for COVID-19? PSM retrospective 198 patients in China No significant difference in mortality c19early.org Chen et al., Cardiology Plus, April 2023 Favorsazvudine Favorscontrol 0 0.5 1 1.5 2+
Azvudine for COVID-19
44th treatment shown to reduce risk in July 2023, now with p = 0.0000034 from 27 studies.
Lower risk for mortality, progression, and viral clearance.
No treatment is 100% effective. Protocols combine treatments.
5,100+ studies for 112 treatments. c19early.org
PSM retrospective 332 hospitalized moderate to critically ill COVID-19 patients with myocardial injury in China, showing improved 14 day mortality but no difference in overall in-hospital mortality with azvudine treatment.
risk of death, 6.5% lower, RR 0.94, p = 0.88, treatment 29 of 99 (29.3%), control 31 of 99 (31.3%), NNT 49, in-hospital mortality, propensity score matching.
risk of death, 63.0% lower, HR 0.37, p = 0.007, treatment 99, control 99, propensity score matching, day 14.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Chen et al., 30 Apr 2023, retrospective, China, peer-reviewed, 9 authors.
This PaperAzvudineAll
Figure S1. Love plot displaying standardized differences for the baseline characteristics by the use of azvudine in patients with myocardial injuries, before and after propensity score matching. SBP: systolic blood pressure; DBP: diastolic blood pressure; RR: respiratory rate; HR: heart rate
{ 'indexed': {'date-parts': [[2024, 2, 23]], 'date-time': '2024-02-23T19:48:28Z', 'timestamp': 1708717708740}, 'reference-count': 30, 'publisher': 'Ovid Technologies (Wolters Kluwer Health)', 'issue': '2', 'license': [ { 'start': { 'date-parts': [[2023, 4, 1]], 'date-time': '2023-04-01T00:00:00Z', 'timestamp': 1680307200000}, 'content-version': 'unspecified', 'delay-in-days': 0, 'URL': 'https://creativecommons.org/licenses/by-sa/4.0/'}], 'content-domain': {'domain': [], 'crossmark-restriction': False}, 'published-print': {'date-parts': [[2023, 4]]}, 'abstract': '<jats:sec>\n' ' <jats:title>Background and purpose:</jats:title>\n' ' <jats:p>Omicron is currently the dominant strain of severe acute respiratory ' 'syndrome coronavirus 2, but little is known about the characteristics and management of ' 'omicron related myocardial injury, particularly the potential benefit of the antiviral agent ' 'azvudine.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Methods:</jats:title>\n' ' <jats:p>Patients with confirmed and suspected coronavirus disease 2019 (COVID-19) ' 'admitted to Wuhan Union Hospital from December 7, 2022, to December 30, 2022, were included ' 'in this study. Cox regression was conducted to identify risk factors for all-cause mortality. ' 'A propensity score-matched analysis was performed at a 1:1 ratio with a caliper of 0.1 pooled ' 'standard deviations of relevant confounders.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Results:</jats:title>\n' ' <jats:p>The final analysis included a total of 332 patients (167 confirmed cases ' 'and 165 suspected cases), 42.77% (142/332) of the patients were 80 years of age or older and ' '68.67% (228/332) of them were men, 158 patients were treated with azvudine. In the matched ' 'cohort, the total mortality was 30.30% (60/198), 40 (20.20%, 40/198) patients received ' 'noninvasive ventilation and 22 (11.11%, 22/198) received invasive ventilation, 34 (17.17%, ' '34/198) patients were admitted to intensive care unit (ICU). The rate of shock, multiple ' 'organ damages and arrhythmia were 11.62% (23/198), 20.20% (40/198), and 12.12% (24/198), ' 'respectively. There was no significant difference on these clinical outcomes in patients ' 'treated with azvudine or not. Azvudine reduced early mortality (within 14 days from ' 'admission) (hazard ratio: 0.37, 95% confidence interval: 0.18–0.77) even after adjusting for ' 'other treatments including glucocorticoids, immunoglobin and anticoagulant therapy, but not ' 'the final in-hospital mortality of patients.</jats:p>\n' ' </jats:sec>\n' ' <jats:sec>\n' ' <jats:title>Conclusions:</jats:title>\n' ' <jats:p>Patients with COVID-19-related myocardial injury had a high mortality of ' 'about 30.30% (60/198). Azvudine improved the early survival of the patients but not final ' 'mortality.</jats:p>\n' ' </jats:sec>', 'DOI': '10.1097/cp9.0000000000000049', 'type': 'journal-article', 'created': {'date-parts': [[2023, 6, 8]], 'date-time': '2023-06-08T10:00:35Z', 'timestamp': 1686218435000}, 'page': '103-110', 'source': 'Crossref', 'is-referenced-by-count': 2, 'title': 'All-cause mortality in moderate and severe COVID-19 patients with myocardial injury receiving ' 'versus not receiving azvudine: a propensity score-matched analysis', 'prefix': '10.1097', 'volume': '8', 'author': [ { 'given': 'Ru', 'family': 'Chen', 'sequence': 'first', 'affiliation': [ { 'name': 'Department of Cardiology, Union Hospital, Tongji Medical ' 'College, Huazhong University of Science and Technology, Wuhan ' '430022, China.'}, { 'name': 'Clinic Center of Human Gene Research, Union Hospital, Tongji ' 'Medical College, Huazhong University of Science and Technology, ' 'Wuhan 430022, China.'}]}, { 'given': 'Yi', 'family': 'Guo', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiology, Union Hospital, Tongji Medical ' 'College, Huazhong University of Science and Technology, Wuhan ' '430022, China.'}, { 'name': 'Clinic Center of Human Gene Research, Union Hospital, Tongji ' 'Medical College, Huazhong University of Science and Technology, ' 'Wuhan 430022, China.'}]}, { 'given': 'Shan', 'family': 'Deng', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiology, Union Hospital, Tongji Medical ' 'College, Huazhong University of Science and Technology, Wuhan ' '430022, China.'}, { 'name': 'Clinic Center of Human Gene Research, Union Hospital, Tongji ' 'Medical College, Huazhong University of Science and Technology, ' 'Wuhan 430022, China.'}]}, { 'given': 'Jian', 'family': 'Wang', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Clinical Laboratory, Union Hospital, Tongji ' 'Medical College, Huazhong University of Science and Technology, ' 'Wuhan 430022, China.'}]}, { 'given': 'Meng', 'family': 'Gao', 'sequence': 'additional', 'affiliation': [ { 'name': 'Liyuan Cardiovascular Center, Tongji Medical College, Huazhong ' 'University of Science and Technology, Wuhan 430022, China.'}]}, { 'given': 'Hongli', 'family': 'Han', 'sequence': 'additional', 'affiliation': [ { 'name': 'Liyuan Cardiovascular Center, Tongji Medical College, Huazhong ' 'University of Science and Technology, Wuhan 430022, China.'}]}, { 'given': 'Lin', 'family': 'Wang', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Clinical Laboratory, Union Hospital, Tongji ' 'Medical College, Huazhong University of Science and Technology, ' 'Wuhan 430022, China.'}, { 'name': 'Research Center for Tissue Engineering and Regenerative ' 'Medicine, Union Hospital, Tongji Medical College, Huazhong ' 'University of Science and Technology, Wuhan 430022, China.'}]}, { 'given': 'Hongwei', 'family': 'Jiang', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Epidemiology and Biostatistics, Ministry of ' 'Education Key Laboratory of Environment and Health, School of ' 'Public Health, Tongji Medical College, Huazhong University of ' 'Science and Technology, Wuhan 430022, China.'}]}, { 'given': 'Kai', 'family': 'Huang', 'sequence': 'additional', 'affiliation': [ { 'name': 'Department of Cardiology, Union Hospital, Tongji Medical ' 'College, Huazhong University of Science and Technology, Wuhan ' '430022, China.'}, { 'name': 'Clinic Center of Human Gene Research, Union Hospital, Tongji ' 'Medical College, Huazhong University of Science and Technology, ' 'Wuhan 430022, China.'}, { 'name': 'Hubei Key Laboratory of Metabolic Abnormalities and Vascular ' 'Aging, Huazhong University of Science and Technology, Wuhan ' '430022, China.'}, { 'name': 'Hubei clinical research center of metabolic and cardiovascular ' 'disease, Huazhong University of Science and Technology, Wuhan ' '430022, China.'}]}], 'member': '276', 'published-online': 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myocarditis: the possible pathophysiology ' 'and proposed guideline for diagnosis and management.', 'volume': '17', 'author': 'Siripanthong', 'year': '2020', 'journal-title': 'Heart Rhythm'}, { 'key': 'R29-20230720', 'first-page': 'E006', 'article-title': 'Myocardial injury in patients with COVID-19 pneumonia.', 'volume': '48', 'author': 'Wei', 'year': '2020', 'journal-title': 'Zhonghua Xin Xue Guan Bing Za Zhi'}, { 'key': 'R30-20230720', 'first-page': '100321', 'article-title': 'The first Chinese oral anti-COVID-19 drug Azvudine launched.', 'volume': '3', 'author': 'Yu', 'year': '2022', 'journal-title': 'Innovation (Camb)'}], 'container-title': 'Cardiology Plus', 'original-title': [], 'language': 'en', 'link': [ { 'URL': 'https://journals.lww.com/10.1097/CP9.0000000000000049', 'content-type': 'unspecified', 'content-version': 'vor', 'intended-application': 'similarity-checking'}], 'deposited': { 'date-parts': [[2023, 7, 20]], 'date-time': '2023-07-20T13:27:44Z', 'timestamp': 1689859664000}, 'score': 1, 'resource': {'primary': {'URL': 'https://journals.lww.com/10.1097/CP9.0000000000000049'}}, 'subtitle': [], 'short-title': [], 'issued': {'date-parts': [[2023, 4]]}, 'references-count': 30, 'journal-issue': {'issue': '2', 'published-print': {'date-parts': [[2023]]}}, 'URL': 'http://dx.doi.org/10.1097/CP9.0000000000000049', 'relation': {}, 'ISSN': ['2470-7511'], 'subject': ['Cardiology and Cardiovascular Medicine'], 'published': {'date-parts': [[2023, 4]]}}
Late treatment
is less effective
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