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All Studies   Meta Analysis    Recent:   

Azvudine versus Paxlovid for oral treatment of COVID-19 in Chinese patients with pre-existing comorbidities

Dian et al., Journal of Infection, doi:10.1016/j.jinf.2023.05.012
Aug 2023  
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Mortality 64% Improvement Relative Risk Ventilation 67% ICU admission 0% Composite outcome 48% Respiratory support 44% Azvudine for COVID-19  Dian et al.  LATE TREATMENT Is late treatment with azvudine beneficial for COVID-19? PSM retrospective 2,118 patients in China (December 2022 - January 2023) Study compares with paxlovid, results vs. placebo may differ Lower progression with azvudine (p=0.03) Dian et al., J. Infection, August 2023 Favorsazvudine Favorspaxlovid 0 0.5 1 1.5 2+
Azvudine for COVID-19
44th treatment shown to reduce risk in July 2023
*, now with p = 0.00022 from 20 studies.
No treatment is 100% effective. Protocols combine treatments. * >10% efficacy, ≥3 studies.
4,400+ studies for 79 treatments.
Retrospective 2,118 hospitalized COVID-19 patients in China, showing improved results with azvudine vs. paxlovid.
Study covers paxlovid and azvudine.
risk of death, 63.6% lower, RR 0.36, p = 0.11, treatment 4 of 228 (1.8%), control 11 of 228 (4.8%), NNT 33, propensity score matching.
risk of mechanical ventilation, 66.7% lower, RR 0.33, p = 0.28, treatment 2 of 228 (0.9%), control 6 of 228 (2.6%), NNT 57, propensity score matching.
risk of ICU admission, no change, RR 1.00, p = 1.00, treatment 1 of 228 (0.4%), control 1 of 228 (0.4%), propensity score matching.
composite outcome, 48.4% lower, RR 0.52, p = 0.03, treatment 16 of 228 (7.0%), control 31 of 228 (13.6%), NNT 15, non-invasive respiratory support, endotracheal intubation, ICU admission, all-cause death, propensity score matching.
respiratory support, 44.4% lower, RR 0.56, p = 0.07, treatment 15 of 228 (6.6%), control 27 of 228 (11.8%), NNT 19, propensity score matching.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Dian et al., 31 Aug 2023, retrospective, China, peer-reviewed, 5 authors, study period 5 December, 2022 - 31 January, 2023, this trial compares with another treatment - results may be better when compared to placebo.
This PaperAzvudineAll
Abstract: Journal of Infection 87 (2023) e24–e27 Contents lists available at ScienceDirect Journal of Infection journal homepage: Letter to the Editor Azvudine versus Paxlovid for oral treatment of COVID-19 in Chinese patients with pre-existing comorbidities ]]]] ]] Dear Editor, Chinese guidelines grant the use of Azvudine and Paxlovid in COVID-19 patients, especially those with pre-existing comorbid­ ities.1,2 Recently, Gao Y et al. reported that Paxlovid appears to be superior to Azvudine in the virus clearance among general COVID-19 patients.3 However, a multicenter randomized controlled study de­ monstrated that Paxlovid showed no significant reduction in the risk of all-cause mortality on day 28 and the duration of virus clearance in hospitalized adult COVID-19 patients with pre-existing co­ morbidities.4 Several studies demonstrated that Azvudine could re­ duce the duration of virus clearance and improve the clinical prognosis in COVID-19 patients including those with pre-existing comorbidities.5–8 Therefore, concerns arise about the clinical effec­ tiveness of Azvudine versus Paxlovid in COVID-19 patients with preexisting comorbidities on admission. Here, we conducted a single-center, retrospective cohort study during the outbreak caused by the omicron from December 5, 2022 to January 31, 2023 in Xiangya Hospital of Central South University. The study included hospitalized patients with preexisting comorbidities and confirmed diagnosis of SARS-CoV-2 infection who received Paxlovid or Azvudine. The patients with these conditions were excluded: 1) younger than 18 years; 2) re­ ceived oxygen support or mechanical ventilation on the date of the admission; 3) not received any antiviral agents; 4) received both Azvudine and Paxlovid. The study was approved by the in­ stitutional review board of Xiangya Hospital of Central South University, and all the patients were anonymous and no need for individual informed consent. The primary endpoint was a composite disease progression outcome which was defined as any of the following events: 1) noninvasive respiratory support; 2) initiation of endotracheal intuba­ tion; 3) intensive care unit admission; 4) all-cause death. The sec­ ondary endpoints were each of these individual disease progression outcomes. Patients were observed from the date of admission until discharge, occurrence of outcome event or death, whichever came first. We used propensity-score models conditional on baseline characteristics, and the probability of receiving Azvudine was esti­ mated in an approach of calliper matching without replacement, with a calliper width of 0.2. The baseline covariates included age, sex, time from symptom onset to hospitalization, COVID-19 vacci­ nation status, severity of COVID-19 on admission (severe cases were defined as having respiratory rate ≥30, or oxygen saturation ≤93%, or PaO2/FiO2 ≤300 mmHg, or lung infiltrates > 50%), and concomitant treatments initiated at admission (systemic steroid and antibiotics). The standard mean differences (SMDs) were used to assess the balance of each baseline covariates between the groups before and after propensity-score matching which less than 0.1 indicating covariate was balanced.9 The incidence rates of outcome events were calculated as the number of outcome events / (sum of person × hospital days). Univariate Cox regression model was used to estimate a hazard ratio (HR) with 95% confidence interval (CI) for each..
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Late treatment
is less effective
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