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. 2023 Dec 22:16:7797-7808.
doi: 10.2147/IDR.S433186. eCollection 2023.

Comparison of Azvudine and Nirmatrelvir/Ritonavir and Combined Use in Patients with COVID-19

Cheng-Yi Hu  1 , Wen-Shuai Cui  1 , Yi Lei  1 , Yu-Wen Tang  1 , Yan-Yan Zhang  1 , Qi-Min Su  1 , Fang Peng  2 , Yun-Fei Zeng  1 , Jia-Lin Song  1 , Cheng-Na Luo  1 , Yan Zhou  1 , Xin-Yan Li  1 , Zhu-Xiang Zhao  1
Affiliations

Comparison of Azvudine and Nirmatrelvir/Ritonavir and Combined Use in Patients with COVID-19

Cheng-Yi Hu et al. Infect Drug Resist. .

Abstract

Purpose: To compare the effectiveness of azvudine and nirmatrelvir/ritonavir for the treatment of coronavirus disease (COVID-19).

Patients and methods: We conducted a retrospective analysis of data from 576 patients with COVID-19, comprising 195 patients without antiviral therapy, 226 patients treated with azvudine, 114 patients treated with nirmatrelvir/ritonavir, and 41 patients were treated with azvudine and nirmatrelvir/ritonavir concurrently. We compared their symptoms, mortality rates, and the length and cost of hospitalization.

Results: The incidence of symptoms was similar in patients treated with azvudine and in those treated with nirmatrelvir/ritonavir. However, among patients experiencing weakness, the duration of weakness was significantly shorter in the azvudine group than in the nirmatrelvir/ritonavir group (P=0.029). Mortality did not differ significantly between the azvudine group and the nirmatrelvir/ritonavir group (18.14% vs.10.53%, P=0.068). Among "severe patients", the mortality rate was markedly lower in patients treated with nirmatrelvir/ritonavir than in patients treated with azvudine (16.92% vs.32.17%, P=0.026). In patients with hepatic insufficiency, those treated with nirmatrelvir/ritonavir had substantially lower mortality than those treated with azvudine (15.09% vs.34.25%, P=0.016). In addition, patients treated with nirmatrelvir/ritonavir had longer hospital stays (P=0.002) and higher hospital costs (P<0.001) than those receiving azvudine. Compared with patients treated with nirmatrelvir/ritonavir or azvudine alone, patients taking nirmatrelvir/ritonavir and azvudine concurrently had no significant improvement in survival (P>0.05), length of stay (P>0.05), or hospital costs (P>0.05).

Conclusion: Azvudine is recommended for patients with non-severe COVID-19 with weakness. Nirmatrelvir/ritonavir is recommended for patients with severe COVID-19, to reduce mortality, and it could be the best choice for patients with hepatic insufficiency. The concurrent use of nirmatrelvir/ritonavir and azvudine in patients with COVID-19 could be not recommended.

Keywords: COVID-19; SARS-CoV-2; azvudine; nirmatrelvir/ritonavir.

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Conflict of interest statement

The authors have no competing interests to declare that are relevant to the content of this article.

Figures

Figure 1
Figure 1
Flowchart of patient selection.
Figure 2
Figure 2
Comparison of the incidence of cough, fever, myalgia, pharyngitis, weakness, and shortness of breath in the azvudine and nirmatrelvir/ritonavir groups.
Figure 3
Figure 3
The duration of cough, fever, myalgia, pharyngitis, weakness, and shortness of breath in the azvudine, nirmatrelvir/ritonavir, and control (no antiviral therapy) groups.
Figure 4
Figure 4
The mortality rates in the azvudine, nirmatrelvir/ritonavir, and control (no antiviral therapy) groups.
Figure 5
Figure 5
Length of hospital stay and cost of hospitalisation in the azvudine, nirmatrelvir/ritonavir, and control (no antiviral therapy) groups.
Figure 6
Figure 6
The survival rate, length of stay, and hospitalisation cost in patients with COVID-19 taking nirmatrelvir/ritonavir and azvudine concurrently.
See this image and copyright information in PMC

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