Effectiveness and safety of azvudine in COVID-19: A systematic review and meta-analysis

Abstract

Objective: The aim of this study was to assess the effectiveness and safety of azvudine in treating coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-COV-2).

Methods: A search was carried out in PubMed, Cochrane Library, Web of Science, medRxiv, and Google Scholar until October 20, 2023. The Cochrane risk of bias tools were used to assess the quality of included studies. Comprehensive Meta-Analysis software was used to analyze data.

Results: Twenty-one studies including 10,011 patients were examined. The meta-analysis results showed that azvudine and standard of care/placebo (SOC/PBO) were significantly different concerning mortality rate (risk ratio [RR] = 0.48, 95% confidence interval [CI]: 0.40 to 0.57) and negative polymerase chain reaction (PCR) conversion time (standard mean difference = - 0.75, 95% CI: -1.29 to-0.21). However, the two groups did not show significant differences concerning hospital stay, intensive care unit (ICU) admission, and need for mechanical ventilation (P > 0.05). On the other hand, azvudine and nirmatrelvir-ritonavir were significantly different in mortality rate (RR = 0.73, 95% CI: 0.58 to 0.92), ICU admission (RR = 0.41, 95% CI: 0.21 to 0.78), and need for mechanical ventilation (RR = 0.67, 95% CI: 0.51 to 0.89), but the two treatments were not significantly different in negative PCR conversion time, and hospital stay (P > 0.05). The incidence of adverse events between groups was not significant (P > 0.05). The certainty of evidence was rated as low or moderate.

Conclusions: The antiviral effectiveness of azvudine against SARS-COV-2 is questionable with regard to the certainty of evidence. Further research should be conducted to establish the effectiveness and safety of azvudine in COVID-19.

Fig 1. PRISMA flow chart of literature screening.

Fig 2. Forest plot of Azvudine vs. standard of care/placebo (SOC/PBO) for mortality rate.

Fig 3. Forest plot of Azvudine vs. nirmatrelvir-ritonavir for mortality rate.

Fig 4. Forest plot of Azvudine vs. standard of care/placebo (SOC/PBO) for negative PCR conversion time.

Fig 5. Forest plot of Azvudine vs. nirmatrelvir-ritonavir for negative PCR conversion time.

Fig 6. Forest plot of Azvudine vs. standard of care/placebo (SOC/PBO) for hospital stay.

Fig 7. Forest plot of Azvudine vs. nirmatrelvir-ritonavir for hospital stay.

Fig 8. Forest plot of Azvudine vs. standard of care/placebo (SOC/PBO) for adverse events.