Azvudine for the treatment of cancer patients with COVID-19: a multicenter, real-world, retrospective, cohort study
et al., BMC Cancer, doi:10.1186/s12885-026-15800-1, Mar 2026
Azvudine for COVID-19
48th treatment shown to reduce risk in
January 2023, now with p = 0.0000000041 from 40 studies.
No treatment is 100% effective. Protocols
combine treatments.
6,400+ studies for
210+ treatments. c19early.org
|
Retrospective 1,829 hospitalized cancer patients with COVID-19 in China showing lower mortality and disease progression with azvudine treatment.
While the authors used a PSM-matched cohort for efficacy, they used 'Available data' (unmatched cohorts: Control n=5609, Azvudine n=593) for the safety analysis in Table 2. In the unmatched data, the azvudine group had significantly higher baseline severity (21.8% severe vs 8.7% in control). Therefore the reported 'distinct toxicity profile' (e.g., higher hypokalemia, lymphocyte changes) is confounded by the fact that the azvudine group was substantially sicker at baseline.
The control group has 105 events over 11,009 person-days (1,200 patients), while the azvudine group has 47 events over 7,612 person-days (629 patients), or roughly 9.2 person-days per patient in the control group versus 12.1 person-days per patient in the azvudine group. If censoring at discharge were non-informative, we would expect roughly similar average follow-up times between groups. Instead, control patients have substantially shorter follow-up on average. This suggests control patients were being discharged (and thus censored) earlier, and since these are the patients who survived to discharge, healthier control patients are being removed from the risk set sooner. That preferentially leaves sicker control patients under observation, inflating the apparent mortality rate in the control group relative to the azvudine group. The raw HR of ~0.86 from the death counts in the PSM groups may be more accurate.
On page 12, the text states '47 deaths occurred in the azvudine group compared with 104 in the control group.' However, the forest plot in Figure 3 explicitly lists '105' events for the control group under all-cause death.
The observation endpoint is defined as 'discharge date, or day 30'. Patients who recover and are discharged early are censored from the mortality analysis at that time. Because healthier patients have systematically shorter follow-up times, this introduces informative censoring that biases the Kaplan-Meier estimates and person-time incidence calculations.
Table 2 contains several calculation errors. For example, azvudine hypokalemia is reported as 193/456 (42.32%) but listed as 43%; control ALT increased is 256/1779 (14.39%) but listed as 14.7%; azvudine lymphocyte count decreased is 220/593 (37.09%) but listed as 36.9%.
The authors state 'All authors declare that they have no competing interests.' However, the senior author (Z.R.) was the lead investigator on previous trials establishing avudine's efficacy.
Table 1 reports continuous variables using mean and standard deviation for laboratory parameters where the standard deviation drastically exceeds the mean. Because these values cannot be negative, this indicates extreme right-skewness, making mean/SD statistically misleading.
Standard of Care (SOC) for COVID-19 in the study country,
China, is average with moderate efficacy for approved treatments3.
This study is excluded in the after exclusion results of meta-analysis:
potential significant differential censoring.
|
risk of death, 35.0% lower, HR 0.65, p = 0.02, treatment 629, control 1,200, propensity score matching, Cox proportional hazards.
|
|
risk of progression, 30.0% lower, HR 0.70, p = 0.02, treatment 629, control 1,200, propensity score matching, Cox proportional hazards.
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
1.
Xiong et al., Real-world data of Azvudine-induced hepatotoxicity among hospitalized COVID-19 patients in China: a retrospective case-control study, Frontiers in Pharmacology, doi:10.3389/fphar.2025.1558054.
Li et al., 4 Mar 2026, retrospective, China, peer-reviewed, 14 authors, study period 5 December, 2022 - 31 January, 2023.
Contact: fccrenzg@zzu.edu.cn, johnyuem@zzu.edu.cn.
Abstract: BMC Cancer
https://doi.org/10.1186/s12885-026-15800-1
Article in Press
Azvudine for the treatment of cancer patients
with COVID-19: a multicenter, real-world,
retrospective, cohort study
Lei Li, Wenjie Liu, Ling Wang, Mengzhao Yang, Juan Wang, Guotao Li, Guowu Qian,
Shixi Zhang, Donghai Liu, Hong Luo, Silin Li, Donghua Zhang, Zujiang Yu & Zhigang
Ren
Received: 19 August 2025
Accepted: 24 February 2026
Cite this article as: Li L., Liu W.,
Wang L. et al. Azvudine for the
treatment of cancer patients with
COVID-19: a multicenter, real-world,
retrospective, cohort study. BMC
Cancer (2026). https://doi.org/10.1186/
s12885-026-15800-1
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ARTICLE IN PRESS
Title Page
Azvudine for the Treatment of Cancer Patients with COVID-19: A
multicenter, real-world, retrospective, cohort study
Authors
Lei Li 1†, Wenjie Liu 2†, Ling Wang 3, Mengzhao Yang 1, Juan Wang 4,
Guotao Li 5, Guowu Qian 6, Shixi Zhang 7, Donghai Liu 3, Hong Luo 8, Silin
S
S
E
R
P
Li 9, Donghua Zhang 10, Zujiang Yu 1*, Zhigang Ren 1*
Affiliations
1
IN
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C
I
T
R
A
Department of Infectious Diseases, State Key Laboratory of Antiviral Drugs, Pingyuan
Laboratory, the First Affiliated Hospital of Zhengzhou University, Zhengzhou 450052,
China;
2
Pain Department of the First Affiliated Hospital of Zhengzhou University, Zhengzhou
450052, China;
3
Department of Clinical Laboratory, Henan Provincial Chest Hospital Affiliated of
Zhengzhou University, Zhengzhou 450008, China;
4
Department of Liver Disease, the Affiliated Infectious Disease Hospital of Zhengzhou
University, Zhengzhou 450052, China;
5
Department of Infectious Diseases, Luoyang Central Hospital Affiliated of Zhengzhou
University, Luoyang 471000, China;
1
ARTICLE IN PRESS
6
Department of Gastrointestinal Surgery, Nanyang Central Hospital, Nanyang 473009,
China;
7
Department of Infectious Diseases, Shangqiu Municipal Hospital, Shangqiu 476000,
China;
8
Guangshan County People’s Hospital, Guangshan County, Xinyang 465450, China;
9
Department of Respiratory and..
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Late treatment
is less effective
is less effective
