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Effects of leritrelvir for adults with mild-to-moderate coronavirus disease 2019: A multicenter real-world study

Cheng et al., Journal of Thoracic Disease, doi:10.21037/jtd-2026-2569, ChiCTR2300077635, Oct 2026
Early treatmentProspective · 1,527 patients · China · May 2023 – May 2024
Leritrelvir for COVID-19
Cheng et al. J. Thoracic Disease · October 2026 · ChiCTR2300077635
Improved recovery and viral clearance
p < 0.0001 (recovery) and p = 0.035 (viral clearance)
Prospective study of 1,527 adults with mild-to-moderate COVID-19 showing faster sustained symptom resolution with leritrelvir. There were no deaths or progression to severe COVID-19.
Standard of Care (SOC) for COVID-19 in the study country, China, is average with moderate efficacy for approved treatments1.
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risk of no recovery, 39.8% lower, HR 0.60, p < 0.001, treatment 1,388, control 139, adjusted per study, inverted to make HR<1 favor treatment, sustained symptom resolution, multivariable, Cox proportional hazards, day 28.
risk of no recovery, 44.8% lower, HR 0.55, p < 0.001, treatment 136, control 136, inverted to make HR<1 favor treatment, sustained symptom resolution, propensity score matching, Cox proportional hazards, day 28.
recovery time, 25.0% lower, relative time 0.75, p < 0.001, treatment 6.0 [5.0-6.0] n=136, control 8.0 [8.0-9.0] n=136, median days to sustained symptom resolution, propensity score matching, Kaplan-Meier.
risk of no viral clearance, 18.0% lower, HR 0.82, p = 0.04, treatment 1,388, control 139, adjusted per study, inverted to make HR<1 favor treatment, negative conversion, multivariable, Cox proportional hazards.
risk of no viral clearance, 32.0% lower, HR 0.68, p < 0.001, treatment 136, control 136, inverted to make HR<1 favor treatment, negative conversion, propensity score matching, Cox proportional hazards.
time to viral-, 25.0% lower, relative time 0.75, p = 0.006, treatment 3.0 [2.0-3.0] n=136, control 4.0 [3.0-4.0] n=136, median days to negative conversion, propensity score matching, Kaplan-Meier.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Cheng et al., 31 Oct 2026, prospective, China, peer-reviewed, 34 authors, study period 22 May, 2023 - 4 May, 2024, trial ChiCTR2300077635. Contact: nanshan@vip.163.com, hejx@vip.163.com, jeffyah@163.com.
$0 $500 $1,000+ Efficacy vs. cost for COVID-19 treatment protocols c19early.org November 2026 China Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Nepal Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Bosnia-Herzegovina Dominican Republic Bolivia Côte d'Ivoire Eritrea Togo Bulgaria Greece Slovakia Iceland New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel Haiti North Macedonia Hong Kong Qatar Panama Serbia Benin Burundi Cameroon CAR China favored low-cost treatments.The average efficacy of treatments was moderate.Low-cost treatments improve early treatment, andprovide complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
$0 $500 $1,000+ Efficacy vs. cost for COVID-19treatment protocols worldwide c19early.org November 2026 China Angola Colombia Kenya Mozambique Myanmar South Africa Peru Philippines USA Brazil France Italy Canada Pakistan Spain Vietnam Japan Iran Bangladesh Ethiopia Ghana Germany Mexico South Korea United Kingdom Saudi Arabia Algeria Morocco Yemen Poland Thailand Uganda Egypt Nigeria Taiwan Fiji Zambia Dominican Rep. Bolivia Côte d'Ivoire Eritrea Togo Sri Lanka Bulgaria Greece Slovakia New Zealand Trinidad and Tobago Mongolia Czechia Belarus Israel North Macedonia Hong Kong Qatar Panama Serbia Benin Burundi CAR Syria China favored low-cost treatments.The average efficacy was moderate.Low-cost protocols improve early treatment,and add complementary/synergistic benefits. More effective More expensive 75% 50% 25% ≤0%
Abstract: Page 1 of 16 Effects of leritrelvir for adults with mild-to-moderate coronavirus disease 2019: a multicenter real-world study Lin-Ling Cheng 1,2# , Ming-Qing Lu 1,2# , Bang-Han Ding 3# , Hui-Qing Zeng 4# , Tian-Xin Xiang 5# , Wei-Dong Weng 6# , Xu-Jing Liang 7# , Jie Jin 8# , Zi-Hao Liu 1 , Hai-Ping Dong 9 , Hui-Lin Wang 10 , Chen-Li Xie 11 , Run-Qi Luo 12 , Xue-Bing Rong 13 , Li-Li Yue 14 , Jun-Rui Li 15 , Feng Li 16 , Yu-Ping Wei 17 , San-Jing Li 18 , Chao Xu 19 , Chi-Guan Li 20 , Hong-Yan Yu 21 , Fei Wei 22 , Wen-Quan Li 23 , Hui-Feng Wang 24 , Chuan-Liu Yang 25 , Bang-Qiong Weng 26 , Liang Wang 27 , De-Qiang Wang 28 , Peng-Yu Zhang 29 , Zheng-Hao Tang 30 , Zi-Feng Yang 1,2 , Jian-Xing He 1,2 , Nan-Shan Zhong 1,2 1 State Key Laboratory of Respiratory Disease, National Clinical Research Center for Respiratory Disease, Guangzhou Institute of Respiratory Health, The First Affiliated Hospital of Guangzhou Medical University, Guangzhou, China; 2 Guangzhou National Laboratory, Guangzhou, China; 3 Emergency Department, The Second Affiliated Hospital of Guangzhou University of Chinese Medicine (Guangdong Provincial Hospital of Chinese Medicine), Guangzhou, China; 4 Teaching Hospital of Fujian Medical University, Xiamen, China; 5 Department of Infectious Diseases, The First Affiliated Hospital of Nanchang University, Nanchang University, Nanchang, China; 6 Zhejiang Institute of Traditional Chinese Medicine, Hangzhou, China; 7 Division of Infectious Disease, The First Affiliated Hospital of Jinan University, Guangzhou, China; 8 Key Laboratory of Hematopoietic Malignancies, The First Affiliated Hospital of Zhejiang University, Hangzhou, China; 9 Department of Severe Tuberculosis Medicine, Guangzhou Chest Hospital, Guangzhou, China; 10 Zhengzhou Third People's Hospital, Zhengzhou, China; 11 Dongguan Binhai Bay Central Hospital, Dongguan, China; 12 Department of Infectious Diseases, The Second Affiliated Hospital Guangzhou Medical University, Guangzhou, China; 13 Baoding First Hospital, Baoding, China; 14 Luoyang First People's Hospital, Luoyang, China; 15 Tangshan Central Hospital, Tangshan, China; 16 The Second Affiliated Hospital of Henan University of Science and Technology, Luoyang, China; 17 Chizhou People's Hospital, Chizhou, China; 18 Zhengzhou Sixth People's Hospital, Zhengzhou, China; 19 Zhengzhou Central Hospital, Zhengzhou, China; 20 The Fourth People's Hospital of Chenzhou, Chenzhou, China; 21 Hebei University of Engineering Affiliated Hospital, Handan, China; 22 Henan Provincial Traditional Chinese Medicine Hospital, Zhengzhou, China; 23 Yibin Second People's Hospital, Yibin, China; 24 Julu County Hospital, Xingtai, China; 25 Huainan Oriental Hospital Group Cancer Hospital, Huainan, China; 26 Pengzhou People's Hospital, Pengzhou, China; 27 Hebei Provincial Chest Hospital, Shijiazhuang, China; 28 Yiyang Central Hospital, Yiyang, China; 29 Shanghai First People's Hospital, Shanghai, China; 30 Shanghai Sixth People's Hospital, Shanghai, China Contributions: (I) Conception and design: LL Cheng, NS Zhong, JX He, ZF Yang; (II) Administrative support: All authors; (III) Provision of study materials or patients: All authors; (IV) Collection and assembly of data: LL Cheng, HQ Zeng, BH Ding, TX Xiang, WD Weng, XJ Liang, J Jin, ZH Liu, HP Dong, HL Wang, CL Xie, RQ Luo, XB Rong, LL Yue, JR Li, F Li, YP Wei, SJ Li, C Xu, CG Li, HY Yu, F Wei, WQ Li, HF Wang, CL Yang, BQ Weng, L Wang, DQ Wang, PY Zhang, ZH Tang, ZF Yang, JX He; (V) Data..
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