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0 0.5 1 1.5 2+ Ventilation -280% Improvement Relative Risk ICU admission -659% AKI -207% Paxlovid for COVID-19  Fu et al.  LATE TREATMENT Is late treatment with paxlovid beneficial for COVID-19? Retrospective 111 patients in China (December 2022 - January 2023) Study compares with azvudine, results vs. placebo may differ Higher progression with paxlovid (p=0.0047) Fu et al., Authorea, Inc., June 2023 Favors paxlovid Favors azvudine

Comparison of the Different Medications for COVID-19 in Kidney Transplant Recipients

Fu et al., Authorea, Inc., doi:10.22541/au.168777909.90198442/v1
Jun 2023  
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Retrospective 140 kidney transplant patients, showing higher risk of AKI with paxlovid compared with azvudine. There were more severe cases in the paxlovid group at baseline.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid Hoertel. 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" FDA.
This study is excluded in the after exclusion results of meta analysis: excessive unadjusted differences between groups.
risk of mechanical ventilation, 279.6% higher, RR 3.80, p = 0.32, treatment 3 of 49 (6.1%), control 1 of 62 (1.6%).
risk of ICU admission, 659.2% higher, RR 7.59, p = 0.04, treatment 6 of 49 (12.2%), control 1 of 62 (1.6%).
AKI, 207.3% higher, RR 3.07, p = 0.005, treatment 17 of 49 (34.7%), control 7 of 62 (11.3%).
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Fu et al., 26 Jun 2023, retrospective, China, preprint, mean age 47.3, 8 authors, study period December 2022 - January 2023, this trial compares with another treatment - results may be better when compared to placebo.
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This PaperPaxlovidAll
Comparison of the Different Medications for COVID-19 in Kidney Transplant Recipients
Yingxin Fu, Jianyong Pan, Weijun Chen, Yitao Zheng, Zixuan Wu, Yongdong Liu, Yuanzheng Peng, Hongzhou Lu
Background We analyzed the effects of small-molecule antiviral treatment for coronavirus disease-2019 (COVID-19) Omicron strain in kidney transplant recipients. Methods We enrolled 140 kidney transplant patients admitted for COVID-19-related pneumonia were treated using small-molecule antivirals. Patients were divided into three groups: azvudine (n=62), paxlovid (n=49), and a combination of azvudine+paxlovid (A+P, n=29). Differences in clinical outcomes owing to COVID-19 infections were compared among three groups. Results Paxlovid group had a higher proportion of comorbid diabetes than the other two groups (P=0.032). There were differences in the clinical typing of the coronavirus , with the highest proportion of heavy and critical cases in the A+P group (35.5%). The immunosuppression prior to infection did not differ among the groups; however, after adjusting for immunosuppression during antiviral treatment, differences were observed. Of the 140 patients, 125 (89.29%) had fever, 114 (81.43%) had cough, and 66 (47.1%) had malaise. Combination of two or more symptoms were found in 90% patients. Mean length of hospitalization was slightly longer in the combination group than in the azvudine and paxlovid groups. Four deaths, all in the A+P group; five cases of loss of function, two in the paxlovid group and three in the A+P group; and acute kidney injury occurred in 30 patients with 7 in the azvudine, 17 in paxlovid, and 6 in A+P groups. Conclusion The use of small-molecule medications may be the optimal treatment approach; however, they should be modified based on the patients' conditions, such as clinical symptoms, laboratory results, paraclinicals, and examinations.
CONCLUSION The use of small-molecule medications may be the optimal treatment approach; however, they should be modified based on the patients' conditions, such as clinical symptoms, laboratory results, paraclinicals, and examinations. References
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Late treatment
is less effective
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