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Real-world effectiveness of azvudine versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19 and pre-existing diabetes

Su et al., iScience, doi:10.1016/j.isci.2025.111907
Jan 2025  
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Retrospective 954 hospitalized patients with COVID-19 and pre-existing diabetes showing lower mortality with azvudine compared to paxlovid, but no significant difference for composite disease progression.
Resistance. Variants may be resistant to paxlovid1-4. Use may promote the emergence of variants that weaken host immunity and potentially contribute to long COVID5.
Confounding by contraindication. Hoertel et al. find that over 50% of patients that died had a contraindication for the use of Paxlovid6. 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"7.
AKI. Kamo et al. show significantly increased risk of acute kidney injury.
Study covers azvudine and paxlovid.
Su et al., 27 Jan 2025, retrospective, China, peer-reviewed, 19 authors, study period 5 December, 2022 - 31 January, 2023. Contact: johnyuem@zzu.edu.cn (corresponding author), johnyuem@zzu.edu.cn (corresponding author), fccrenzg@zzu.edu.cn.
This PaperPaxlovidAll
Real-world effectiveness of azvudine versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19 and pre-existing diabetes
Guanyue Su, Silin Li, Donghua Zhang, Yongjian Zhou, Ling Wang, Yiqiang Yuan, Guowu Qian, Guotao Li, Na Han, Ming Cheng, Guangming Li, Shixi Zhang, Hong Luo, Mengzhao Yang, Yanyang Zhang, Zhan Song, Jiyuan Xing, Zujiang Yu, Zhigang Ren
iScience, doi:10.1016/j.isci.2025.111907
Real-world effectiveness of azvudine versus nirmatrelvir-ritonavir
AUTHOR CONTRIBUTIONS Conceptualization: Z.R. and Z.Y.; resources: Z.R., Z.Y., J.X, Y.Y., H.L., S.Z., G.L., D.Z., and G.L.; data curation: G.S., M.Y., Y.Z., M.C., L.W., N.H., Z.S., G.Q., and Y.Z.; formal analysis: M.Y.; supervision: Z.R. and Z.Y.; funding acquisition: G.S., Z.R., and Z.Y.; writing-original draft: G.S., S.L., and D.Z.; writing-review and editing: G.S., S.L., and D.Z. DECLARATION OF INTERESTS The authors declare no competing interests. STAR+METHODS Detailed methods are provided in the online version of this paper and include the following: STAR+METHODS KEY RESOURCES TABLE EXPERIMENTAL MODEL AND STUDY PARTICIPANT DETAILS Ethics approval and consent to participate This study was reviewed and approved by the Institutional Review Board from The First Affiliated Hospital of Zhengzhou University (2023-KY-0865-001). The retrospective cohort study employing anonymized data did not require individual informed consent. Study design and participants This is a multi-center, retrospective cohort study comparing the effectiveness and safety of azvudine with nirmatrelvir-ritonavir in hospitalized patients with COVID-19 with pre-existing diabetes. We retrieved all hospitalized patients with COVID-19 from nine hospitals in Henan Province (e.g., the First Affiliated Hospital of Zhengzhou University, Henan Provincial Chest Hospital, Henan Infectious Disease Hospital, Luoyang Central Hospital, Nanyang Central Hospital, the Fifth People's Hospital of Anyang, Shangqiu..
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Late treatment
is less effective
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