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Real-world effectiveness of simnotrelvir-ritonavir versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19 during the omicron wave in China: a retrospective cohort study

Li et al., BMC Infectious Diseases, doi:10.1186/s12879-025-11195-9, Jul 2025
https://c19early.org/li42pl.html
Retrospective 585 hospitalized COVID-19 patients in China showing that xiannuoxin provided better clinical improvement than paxlovid. There were no significant differences for progression, mortality, or respiratory support.
Resistance. Variants may be resistant to paxlovid1-7. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID8.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid9. 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 paxlovid10.
Kidney and liver injury. Studies show significantly increased risk of acute kidney injury11 and liver injury12.
Study covers xiannuoxin and paxlovid.
Li et al., 1 Jul 2025, retrospective, China, peer-reviewed, 17 authors, study period 20 December, 2022 - 30 November, 2023. Contact: ydyyzjq@163.com, haopot@163.com.
Real-world effectiveness of simnotrelvir-ritonavir versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19 during the omicron wave in China: a retrospective cohort study
Chuntao Li, Qingzhao Cheng, Ying Chen, Ling Liu, Dajin Liu, Jiaqiang Zhang, Zehua Liao, Yaling Xiang, Jinbiao Zhou, Keke Liao, Yandi Su, Xuemei Zhang, Jiashu Li, Yuping Zhao, Yue Yang, Jianqing Zhang, Long Yang
BMC Infectious Diseases, doi:10.1186/s12879-025-11195-9
Objective This study aims to assess the comparative clinical effectiveness of the 3-chymotrypsin-like protease (3CLpro) inhibitors simnotrelvir-ritonavir and nirmatrelvir-ritonavir in hospitalized patients with COVID-19 during the omicron wave in China. Methods The retrospective analysis of data from adult hospitalized patients with COVID-19 treated with either simnotrelvir-ritonavir or nirmatrelvir-ritonavir as antiviral treatment strategies will be conducted to determine any differences in clinical outcomes between the two drugs. Results This study involved a total of 585 participants, with 264 in the simnotrelvir group and 321 in the nirmatrelvir group. Following propensity score matching, there were 186 individuals in each group. There was no statistically significant difference in the cumulative risk of the composite disease progression, all-cause death, and respiratory support at 28 days following initiation of drug exposure between the two groups (p > 0.05). However, the simnotrelvir group exhibited more cases of clinical improvement compared to the nirmatrelvir group (33.602 events per 1000 person-days vs. 30.913 events per 1000 person-days), with a better cumulative incidence in the simnotrelvir group (p < 0.05). The multivariate Cox regression analysis revealed that non-severe COVID-19 (HR 0.630, 95% CI 0.496-0.801; p < 0.001), lower C-reactive protein (CRP) levels (HR 0.993, 95% CI 0.990-0.997; p < 0.001), and treatment with simnotrelvir-ritonavir (HR 1.395, 95% CI 1.118-1.741; p = 0.003) were independently associated with a higher likelihood of clinical improvement.
Supplementary Information The online version contains supplementary material available at https:// doi. org/ 10. 1186/ s12879-025-11195-9 . Supplementary Material 1. Authors' contributions Declarations Ethics approval and consent to participate This study was conducted in accordance with the ethical principles outlined in the Declaration of Helsinki. Verbal informed consent was obtained from all participants in this study through telephone follow-up procedures. Approval of Clinical Research by the Ethics Committee of the First Affiliated Hospital of Kunming Medical University[(2024 L)No. 75]. Consent for publication Not applicable. Competing interests The authors declare no competing interests. Publisher's Note Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
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Late treatment
is less effective
Please send us corrections, updates, or comments. c19early involves the extraction of 200,000+ 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. IMA and WCH provide treatment protocols.
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