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Efficacy and safety of azvudine versus nirmatrelvir/ritonavir in cancer patients with COVID-19

Jia et al., Scientific Reports, doi:10.1038/s41598-025-85677-w
Mar 2025  
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PSM retrospective 596 cancer patients with COVID-19 showing that azvudine significantly reduced all-cause mortality and composite disease progression compared to paxlovid.
Resistance. Variants may be resistant to paxlovid1-6. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID7.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid8. 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"9.
Kidney and liver injury. Studies show significantly increased risk of acute kidney injury10 and liver injury11.
Study covers azvudine and paxlovid.
Jia et al., 31 Mar 2025, retrospective, China, peer-reviewed, 16 authors, study period 5 December, 2022 - 31 January, 2023. Contact: hxliang@zzu.edu.cn, johnyuem@zzu.edu.cn, fccrenzg@zzu.edu.cn.
This PaperPaxlovidAll
Efficacy and safety of azvudine versus nirmatrelvir/ritonavir in cancer patients with COVID-19
Bohan Jia, Junyi Sun, Di Zhu, Ling Wang, Xiaobo Hu, Haiyu Wang, Guowu Qian, Donghua Zhang, Silin Li, Hong Luo, Shixi Zhang, Guotao Li, Guangming Li, Hongxia Liang, Zujiang Yu, Zhigang Ren
Scientific Reports, doi:10.1038/s41598-025-85677-w
Cancer significantly contributes to the unfavorable prognosis of coronavirus disease 2019 (COVID-19) patients. The efficacy and safety of azvudine and nirmatrelvir/ritonavir (Paxlovid) in cancer patients with COVID-19 remain uncertain. Therefore, we designed a comprehensive retrospective study encompassing clinical data of 32,864 hospitalized COVID-19 patients, 691 of whom were cancer patients treated with azvudine and 200 were cancer patients treated with Paxlovid. After 2:1 propensity score matching, 397 patients in the azvudine group and 199 patients in the Paxlovid group were enrolled. Cox regression analysis revealed the risk of all-cause death (HR: 1.84, 95% CI: 1.059-3.182, P = 0.030) and composite disease progression (HR: 1.70, 95% CI: 1.043-2.757, P = 0.033) were greater in the Paxlovid group than in the azvudine group. Two sensitivity analyses confirmed the robustness of our findings. The safety analysis of adverse events revealed no statistically significant differences between the two groups. In conclusion, we carried out the first analysis to compare the efficacy and safety of azvudine and Paxlovid in cancer patients with COVID-19 and demonstrated that azvudine significantly reduced the risk of all-cause death and composite disease progression among cancer patients with COVID-19 compared with Paxlovid.
Author contributions Bohan Jia, Junyi Sun, Di Zhu, Ling Wang and Xiaobo Hu contributed equally to this work. Hongxia Liang, Zujiang Yu and Zhigang Ren conceived and designed the study; Guowu Qian, Donghua Zhang, Silin Li, Hong Luo, Shixi Zhang, Guotao Li and Guangming Li managed the patients and collected the data; Di Zhu, Haiyu Wang, Ling Wang and Xiaobo Hu analyzed the data; Bohan Jia, Junyi Sun wrote the manuscript; All authors reviewed and approved the manuscript. Competing interests The authors declare no competing interests. Additional information Supplementary Information The online version contains supplementary material available at h t t p s : / / d o i . o r g / 1 0 . 1 0 3 8 / s 4 1 5 9 8 -0 2 5 -8 5 6 7 7 -w . Correspondence and requests for materials should be addressed to H.L., Z.Y. or Z.R. Reprints and permissions information is available at www.nature.com/reprints. Publisher's note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations. Open Access This article is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License, which permits any non-commercial use, sharing, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if you modified the licensed material. You do not have permission under this licence to..
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Late treatment
is less effective
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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