Head-to-head comparison of azvudine and nirmatrelvir/ritonavir for the hospitalized patients with COVID-19: a real-world retrospective cohort study with propensity score matching

DOI record: { "DOI": "10.3389/fphar.2023.1274294", "ISSN": [ "1663-9812" ], "URL": "http://dx.doi.org/10.3389/fphar.2023.1274294", "abstract": "<jats:p><jats:bold>Background:</jats:bold> Nirmatrelvir/ritonavir and azvudine have been approved for the early treatment of COVID-19 in China, however, limited real-world data exists regarding their effectiveness and safety.</jats:p><jats:p><jats:bold>Methods:</jats:bold> We conducted a retrospective cohort study involving the hospitalized COVID-19 patients in China between December 2022 and January 2023. Demographic, clinical, and safety variables were recorded.</jats:p><jats:p><jats:bold>Results:</jats:bold> Among the 6,616 hospitalized COVID-19 patients, we included a total of 725 patients including azvudine recipients (N = 461) and nirmatrelvir/ritonavir (N = 264) recipients after exclusions and propensity score matching (1:2). There was no significant difference in the composite disease progression events between azvudine (98, 21.26%) and nirmatrelvir/ritonavir (72, 27.27%) groups (<jats:italic>p</jats:italic> = 0.066). Azvudine was associated with a significant reduction in secondary outcomes, including the percentage of intensive care unit admission (<jats:italic>p</jats:italic> = 0.038) and the need for invasive mechanical ventilation (<jats:italic>p</jats:italic> = 0.035), while the in-hospital death event did not significantly differ (<jats:italic>p</jats:italic> = 0.991). As for safety outcomes, 33 out of 461 patients (7.16%) in azvudine group and 22 out of 264 patients (8.33%) in nirmatrelvir/ritonavir group experienced drug-related adverse events between the day of admission (<jats:italic>p</jats:italic> = 0.565).</jats:p><jats:p><jats:bold>Conclusion:</jats:bold> In our real-world setting, azvudine treatment demonstrated similar safety compared to nirmatrelvir/ritonavir in hospitalized COVID-19 patients. Additionally, it showed slightly better clinical benefits in this population. However, further confirmation through additional clinical trials is necessary.</jats:p>", "alternative-id": [ "10.3389/fphar.2023.1274294" ], "author": [ { "affiliation": [], "family": "Wei", "given": "An-Hua", "sequence": "first" }, { "affiliation": [], "family": "Zeng", "given": "Lu", "sequence": "additional" }, { "affiliation": [], "family": "Wang", "given": "Lu", "sequence": "additional" }, { "affiliation": [], "family": "Gui", "given": "Lin", "sequence": "additional" }, { "affiliation": [], "family": "Zhang", "given": "Wen-Ting", "sequence": "additional" }, { "affiliation": [], "family": "Gong", "given": "Xue-Peng", "sequence": "additional" }, { "affiliation": [], "family": "Li", "given": "Juan", "sequence": "additional" }, { "affiliation": [], "family": "Liu", "given": "Dong", "sequence": "additional" } ], "container-title": "Frontiers in Pharmacology", "container-title-short": "Front. Pharmacol.", "content-domain": { "crossmark-restriction": true, "domain": [ "frontiersin.org" ] }, "created": { "date-parts": [ [ 2023, 10, 13 ] ], "date-time": "2023-10-13T05:02:57Z", "timestamp": 1697173377000 }, "deposited": { "date-parts": [ [ 2023, 10, 13 ] ], "date-time": "2023-10-13T05:03:00Z", "timestamp": 1697173380000 }, "indexed": { "date-parts": [ [ 2023, 10, 14 ] ], "date-time": "2023-10-14T11:46:17Z", "timestamp": 1697283977332 }, "is-referenced-by-count": 0, "issued": { "date-parts": [ [ 2023, 10, 13 ] ] }, "license": [ { "URL": "https://creativecommons.org/licenses/by/4.0/", "content-version": "vor", "delay-in-days": 0, "start": { "date-parts": [ [ 2023, 10, 13 ] ], "date-time": "2023-10-13T00:00:00Z", "timestamp": 1697155200000 } } ], "link": [ { "URL": "https://www.frontiersin.org/articles/10.3389/fphar.2023.1274294/full", "content-type": "unspecified", "content-version": "vor", "intended-application": "similarity-checking" } ], "member": "1965", "original-title": [], "prefix": "10.3389", "published": { "date-parts": [ [ 2023, 10, 13 ] ] }, "published-online": { "date-parts": [ [ 2023, 10, 13 ] ] }, "publisher": "Frontiers Media SA", "reference": [ { "DOI": "10.1002/jmv.28441", "article-title": "Efficacy and safety of nirmatrelvir/ritonavir (Paxlovid) for COVID-19: a rapid review and meta-analysis", "author": "Amani", "doi-asserted-by": "publisher", "first-page": "e28441", "journal-title": "J. 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