A real-world retrospective analysis comparing the effectiveness of Azvudine and Nirmatrelvir/Ritonavir in COVID-19 patients with diabetes
et al., Scientific Reports, doi:10.1038/s41598-026-42215-6, Mar 2026
Azvudine for COVID-19
48th treatment shown to reduce risk in
January 2023, now with p = 0.0000000015 from 41 studies.
No treatment is 100% effective. Protocols
combine treatments.
6,400+ studies for
210+ treatments. c19early.org
|
Retrospective study of 400 hospitalized COVID-19 patients with diabetes in China showing no significant difference in the composite endpoint of disease progression (all-cause mortality, ICU admission, or invasive mechanical ventilation) between paxlovid and azvudine. Paxlovid showed a non-significant trend toward lower all-cause mortality.
PSM failure: after matching, the cohorts remain severely unbalanced. Chronic respiratory disease prevalence is 11.8% in the azvudine group versus 76.0% in the paxlovid group (SMD = -1.741). Multiple other covariates exceed conventional SMD thresholds (tumor: -0.393, anticoagulant use: -0.617). Authors acknowledge this but proceed with outcome analysis regardless.
Inconsistent matching ratio: authors state they conducted a 1:2 PSM, but post-matching cohort sizes are N=110 and N=75 - a ratio of ~1.47:1, not 2:1 - indicating many patients could not be adequately matched, further reflecting the fundamental dissimilarity between groups.
Overfitting: the matched cohort had only 17 total all-cause death events, yet the authors fit a multivariable Cox model adjusting for age, sex, medical history, and time from symptom onset to hospitalization. This violates the ~10 events-per-variable guideline, rendering the adjusted hazard ratios unreliable.
Forest plot rounding: in Figure 4, multiple HR 95% confidence intervals display an upper bound of exactly "1" (e.g., 0.04 to 1; 0.26 to 1; 0.03 to 1). This is likely a display/rounding artifact rather than true values, but creates apparent inconsistencies - for instance, antibiotics HR 0.50 (0.26 to 1) reaches significance (p=0.045) while hormonal medications HR 0.54 (0.26 to 1) does not (p=0.10).
Study covers azvudine and paxlovid.
Zhu et al., 10 Mar 2026, retrospective, China, peer-reviewed, 19 authors, study period 5 December, 2022 - 31 January, 2023.
Contact: 4@163.com, 6382851@qq.com.
Abstract: Scientific Reports
https://doi.org/10.1038/s41598-026-42215-6
Article in Press
A real-world retrospective analysis comparing
the effectiveness of Azvudine and Nirmatrelvir/
Ritonavir in COVID-19 patients with diabetes
Zefeng Zhu, Qiqin Chen, Zichen Wang, Qijin Chen, Xialing Li, Yeying Liu, Haiqing Lu,
Junyi Feng, Minhui Xie, Xiaomin Dong, Bo Chen, Jingqing Huang, Xian Zeng, Zheng
Zeng, Yan Yuan, Feiyi Xu, Xueyu Liao, Bojia Liang & Wei Chen
Received: 30 August 2025
Accepted: 24 February 2026
Cite this article as: Zhu Z., Chen Q.,
Wang Z. et al. A real-world retrospective
analysis comparing the effectiveness
of Azvudine and Nirmatrelvir/Ritonavir
in COVID-19 patients with diabetes. Sci
Rep (2026). https://doi.org/10.1038/
s41598-026-42215-6
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ARTICLE IN
MANUSCRIPT
PRESS
A Real-World Retrospective Analysis Co
mparing the Effectiveness of Azvudine
and Nirmatrelvir/Ritonavir in COVID-19
Patients with Diabetes
Zefeng Zhu1,11,10,** , Qiqin Chen2,10 ,Zichen Wang3,10,Qijin
Chen4,10,Xialing Li5,10 ,Yeying Liu6, Haiqing lu7 ,Junyi Fen
g8 ,Minhui Xie9, Xiaomin Dong1, Bo Chen1, Jingqing Huan
g1,Xian Zeng1, Zheng Zeng1, Yan Yuan1, Feiyi Xu3 ,Xueyu
Liao3 ,Bojia Liang3, and Wei Chen1,11,*
S
S
E
R
P
Summary
Backgrounds: Azvudine and Nirmatrelvir/Ritonavir have been approved fo
r the treatment of mild to moderate COVID-19 in adults at high risk for pr
ogression to severe disease. Diabetes is a high-risk complication of COVID19. Currently, the effectiveness of Azvudine and Nirmatrelvir/Ritonavir in p
atients with both diabetes and COVID-19 remains unclear. This study aims
to compare the effectiveness of these two drugs in patients with diabetes
and COVID-19.
Methods:
In this retrospective study. This retrospective study analyzed data from 13,
763 hospitalized COVID-19 patients with COVID-19 infection presenting wit
h comorbid diabetes mellitus between December 5, 2022, and January 31,
2023. These patients were from six different hospitals in the GuangXi Zh
uang Autonomous Region, including 288..
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Late treatment
is less effective
is less effective
