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Small-molecule antivirals treatment for COVID-19: A systematic review and network meta-analysis

Zheng et al., International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2024.107096, PROSPERO CRD42023396617
Jan 2024  
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Azvudine for COVID-19
41st treatment shown to reduce risk in July 2023
*, now known with p = 0.00014 from 18 studies.
No treatment is 100% effective. Protocols combine complementary and synergistic treatments. * >10% efficacy in meta analysis with ≥3 clinical studies.
4,000+ studies for 60+ treatments.
Systematic review and network meta-analysis of 160 studies involving over 900,000 COVID-19 patients assessing the efficacy and safety of small-molecule antivirals. For azvudine, significant benefits were found for mortality, mechanical ventilation, clinical improvement, and viral clearance.
2 meta analyses show significant improvements with azvudine for mortality Wang, Zheng, mechanical ventilation Zheng, improvement Zheng, and viral clearance Zheng.
Currently there are 18 azvudine for COVID-19 studies, showing 34% lower mortality [20‑46%], 31% lower ventilation [7‑48%], 47% lower ICU admission [5‑70%], and 43% lower hospitalization [-85‑82%].
Zheng et al., 18 Jan 2024, peer-reviewed, 11 authors, trial PROSPERO CRD42023396617. Contact:,,
This PaperAzvudineAll
Small-molecule antivirals treatment for COVID-19: A systematic review and network meta-analysis
Bei Zheng, Qinqin Zhao, Wenjuan Yang, Pinpin Feng, Chuanwei Xin, Yin Ying, Bo Yang, Bing Han, Jun Zhu, Meiling Zhang, Gonghua Li
International Journal of Antimicrobial Agents, doi:10.1016/j.ijantimicag.2024.107096
Highlights  Systematic review and network meta-analysis assessing the efficacy and safety of small-molecule antivirals treatment for COVID-19.  Proxalutamide, nirmatrelvir/ritonavir, triazavirin, azvudine, molnupiravir, and VV116 were ranked as the most effective drugs overall in both mild-to-moderate and unstratified groups.  In both mild-to-moderate and unstratified groups, leritrelvir ranked first in virus clearance on days 7; however, no significant statistical difference was observed between leritrelvir and the subsequent medications  Simnotrelvir/ritonavir and leritrelvir need further clinical data to confirm their efficacy and safety profiles.  In terms of safety, the incidence of serious adverse events did not demonstrate an increase across all small-molecule antivirals, thereby confirming their favorable tolerability.
Competing Interests: The authors declare no competing interests. Ethical Approval: Not required. Sequence Information: Not applicable
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