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0 0.5 1 1.5 2+ Mortality 13% Improvement Relative Risk Progression -22% Paxlovid for COVID-19  Wang et al.  EARLY TREATMENT Is early treatment with paxlovid beneficial for COVID-19? Retrospective 249 patients in China Higher progression with paxlovid (not stat. sig., p=0.49) Wang et al., eClinicalMedicine, February 2024 Favors paxlovid Favors control

Antiviral effectiveness and survival correlation of azvudine and nirmatrelvir/ritonavir in elderly severe patients with COVID-19: a retrospective real-world study

Wang et al., eClinicalMedicine, doi:10.1016/j.eclinm.2024.102468
Feb 2024  
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Retrospective 249 elderly patients with severe COVID-19, 128 treated with azvudine, 66 treated with paxlovid, and 55 receiving neither treatment, showing no significant differences for Ct value changes, progression, or survival for either treatment. Early viral decline was faster with paxlovid, without statistical significance.
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.
Study covers azvudine and paxlovid.
risk of death, 13.2% lower, HR 0.87, p = 0.67, treatment 66, control 55, adjusted per study, multivariable, Cox proportional hazards.
risk of progression, 22.2% higher, HR 1.22, p = 0.49, treatment 66, control 55, adjusted per study, ICU, mechanical ventilation, or death, multivariable, Cox proportional hazards.
Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates
Wang et al., 9 Feb 2024, retrospective, China, peer-reviewed, 47 authors.
This PaperPaxlovidAll
Antiviral effectiveness and survival correlation of azvudine and nirmatrelvir/ritonavir in elderly severe patients with COVID-19: a retrospective real-world study
Shuxia Wang, Jin Sun, Xin Zhang, Man Li, Bangguo Qin, Miao Liu, Nan Zhang, Shengshu Wang, Tingyu Zhou, Wei Zhang, Cong Ma, Xinli Deng, Yongyi Bai, Geping Qu, Lin Liu, Hui Shi, Bo Zhou, Ke Li, Bo Yang, Suxia Li, Fan Wang, Jinling Ma, Lu Zhang, Yajuan Wang, Li An, Wenhui Liu, Qing Chang, Ru Zhang, Xi Yin, Yang Yang, Qiangguo Ao, Qiang Ma, Shuangtong Yan, Haili Huang, Peng Song, Linggen Gao, Wenning Lu, Lining Xu, Li Lei, Keyu Wang, Qi Zhang, Qing Song, Zhijian Zhang, Xiangqun Fang, Yao He, Tianzhi Li, Ping Zhu
eClinicalMedicine, doi:10.1016/j.eclinm.2024.102468
Background Azvudine and nirmatrelvir/ritonavir are approved to treat mild-to-moderate coronavirus disease 2019 (COVID-19) in adults with a high risk for progression to severe infection. We sought to compare the antiviral effectiveness and clinical outcomes of elderly severe patients with COVID-19 receiving these two antiviral agents. Methods In this observational study, we identified 249 elderly patients with severe COVID-19 infection who were admitted to the Second Medical Center of the People's Liberation Army General Hospital from December 2022 to January 2023, including 128 azvudine recipients, 66 nirmatrelvir/ritonavir recipients and 55 patients not received antiviral treatments. We compared the cycle threshold (Ct) value dynamic change of all three groups. The primary outcome was a composite outcome of disease progression, including all-cause death, intensive care unit admission, and initiation of invasive mechanical ventilation. The outcomes of all enrolled patients were followed up from the electronic medical record system. Kaplan-Meier and Cox risk proportional regression analyses were used to compare the clinical outcomes of all three groups. To more directly compare the effectiveness of the two antiviral drugs, we performed propensity-score matching between the two antiviral groups and compared antiviral efficacy and clinical outcomes in the matched population.
Appendix A. Supplementary data Supplementary data related to this article can be found at https://doi. org/10.1016/j.eclinm.2024.102468.
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