Efficacy of Nirmatrelvir-Ritonavir versus Azvudine for COVID-19 Treatment in Tibet: A Retrospective Study
Xiang Zhao, Yuan Cheng, Meng Zhang, Bianba Qianda, Baima Zhouma, Bianba Yangzhen, Yao Zheng, Shuo Zhang, Huiying Zhao
Infection and Drug Resistance, doi:10.2147/idr.s423725
Background: Nirmatrelvir-ritonavir, also known as paxlovid, is a widely used antiviral drug against coronavirus disease 2019 (COVID-19). Azvudine, a drug previously used to treat human immunodeficiency virus-1, has also been used to treat COVID-19 in China. However, only a few clinical studies have evaluated the effects of azvudine. Additionally, studies comparing nirmatrelvirritonavir with azvudine have been limited in number. Methods: We carried out a retrospective case-control analysis at the Third People's Hospital of the Tibet Autonomous Region. Eighty-two eligible patients with COVID-19 who received azvudine treatment were included. A total of 145 control patients who received nirmatrelvir-ritonavir treatment were selected by propensity score matching for age, sex, the severity of disease, and initial cycle threshold values. A comparison of the nucleic acid test negative conversion time, the length of hospitalization, and mortality rate was conducted. Results: Overall, the mean nucleic acid test negative conversion time was comparable between the nirmatrelvir-ritonavir and azvudine groups (7.0 [11.0, 15.0] vs 9.0 [6.0, 12.0] days, P=0.064). However, for patients with mild COVID-19, the nucleic acid test negative conversion time was significantly shorter in the nirmatrelvir-ritonavir group than in the azvudine group (6.0 [5.0, 8.0] vs 8.0 [6.0, 11.0] days, P=0.029). The nirmatrelvir-ritonavir group and the azvudine group did not differ significantly in length of hospitalization (8.0 [5.5,10.5] vs 8.0 [5.0,10.0] days, P=0.378). Regarding the mortality rate, there were 4 (2.8%) deaths in the nirmatrelvir-ritonavir group and 3 (3.7%) in the azvudine group (P=0.706).
Conclusion: Azvudine is generally as effective as nirmatrelvir-ritonavir, but for patients with mild COVID-19, nirmatrelvir-ritonavir could suppress the virus more rapidly. For those who cannot be treated with nirmatrelvir-ritonavir, azvudine might be an effective therapy for COVID-19.
Patient Consent Statement The research on patients was approved by the Third People's Hospital of the Tibet Autonomous Region Clinical Research Ethics Committee, approval number ME-TBHP-23-03. All patients in the retrospective cohort study were anonymous, and the individual informed consent was not required. The Third People's Hospital of the Tibet Autonomous Region specifically waived the requirement for informed consent.
Author Contributions All authors made a significant contribution to the work reported, whether that was in the conception, study design, execution, acquisition of data, analysis, and interpretation, or in all the following areas; took part in drafting, revised or critically reviewed the article; approved final version of the manuscript; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.
Disclosure The authors declare no conflicts of interest in this work.
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