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Open Access 24-07-2023 | Ritonavir | Original Research

Is Azvudine Comparable to Nirmatrelvir-Ritonavir in Real-World Efficacy and Safety for Hospitalized Patients with COVID-19? A Retrospective Cohort Study

Authors: Qinqin Zhao, Bei Zheng, Bing Han, Pinpin Feng, Zhongni Xia, Hong Jiang, Yin Ying, Jun Zhu, Cheng Fei, Junlei Xiang, Lingli Shen, Qiliang Luo, Yinhuan Wu, Ayiguzhali Wusiman, Chuanwei Xin, Meiling Zhang, Gonghua Li, Xiang Li

Published in: Infectious Diseases and Therapy | Issue 8/2023

Abstract

Introduction

Azvudine and nirmatrelvir-ritonavir are more extensively used to treat COVID-19 in China due to their earlier approval by the National Medical Products Administration. However, there has been a scarcity of research directly comparing the clinical outcomes between azvudine and nirmatrelvir-ritonavir till now. We aimed to make a head-to-head comparison of the efficacy and safety of azvudine or nirmatrelvir-ritonavir in hospitalized patients with COVID-19 in China.

Methods

This retrospective cohort study was conducted using data collected from Tongde Hospital of Zhejiang Province between December 2022 and January 2023. All-cause mortality, risk of progressing to a critical condition, proportion with nucleic-acid negative conversion (P_NANC), time to first nucleic-acid negative conversion (T_FNANC), length of hospital stay and incidence of adverse events were systematically assessed as outcomes. Multi-model regression analysis, propensity-score-matching analysis, subgroup analysis and several sensitivity analyses were applied to compare these outcomes.

Results

This study included a total of 1571 hospitalized patients with COVID-19, among whom 272 received nirmatrelvir-ritonavir and 156 received azvudine. We found no significant differences in all-cause mortality (HR 1.41; 95% CI 0.56–3.56; P = 0.471), risk of progressing to critical COVID-19 (HR 1.67; 95% CI 0.78–3.60; P = 0.189), P_NANC (HR 0.87; 95% CI 0.69–1.09; P = 0.220), length of stay (β − 0.82; 95% CI − 2.78 to 1.15; P = 0.414) and adverse event rate (3.21% vs. 4.41%, P = 0.538) between the two groups, although azvudine was slightly less effective than nirmatrelvir-ritonavir. Meanwhile, the azvudine group exhibited a significantly longer T_FNANC (β 2.53; 95% CI 0.76–4.29; P = 0.005) than the nirmatrelvir-ritonavir group. Results were similar for propensity-score matching and multiple sensitivity analyses.

Conclusion

Azvudine probably possessed comparable efficacy and safety to nirmatrelvir-ritonavir, although it was less effective than nirmatrelvir-ritonavir for some outcomes.

Graphical Abstract

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Title: Is Azvudine Comparable to Nirmatrelvir-Ritonavir in Real-World Efficacy and Safety for Hospitalized Patients with COVID-19? A Retrospective Cohort Study
Authors: Qinqin Zhao
Bei Zheng
Bing Han
Pinpin Feng
Zhongni Xia
Hong Jiang
Yin Ying
Jun Zhu
Cheng Fei
Junlei Xiang
Lingli Shen
Qiliang Luo
Yinhuan Wu
Ayiguzhali Wusiman
Chuanwei Xin
Meiling Zhang
Gonghua Li
Xiang Li
Publication date: 24-07-2023
Publisher: Springer Healthcare
Keywords: Ritonavir
COVID-19
Published in: Infectious Diseases and Therapy / Issue 8/2023
Print ISSN: 2193-8229
Electronic ISSN: 2193-6382
DOI: https://doi.org/10.1007/s40121-023-00845-7

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