Systematic evaluation of therapeutic effectiveness of Azvudine in treating COVID-19 hospitalized patients: a retrospective cohort study

Abstract

Background: Azvudine, a repurposed oral small molecule antiviral drug, has potential effects in combating the SARS-CoV-2 virus. However, studies on its clinical efficacy in patients with COVID-19 are still limited and controversial, and further research and validation are necessary.

Methods: A retrospective cohort study was conducted on COVID-19 patients who were hospitalized in the General Hospital of Central Theater Command from 1 December 2022 to 31 January 2023. We included 132 patients treated with Azvudine and 132 controls after screening and propensity score matching. The primary outcomes including all-cause mortality and a composite outcome of disease progression such as non-invasive respiratory support, invasive respiratory support, admission to intensive care unit (ICU), and death were compared.

Results: Azvudine recipients had a much lower incidence rate of composite disease progression outcome than controls (13.9075/1000 person-days versus 25.7731/1000 person-days, P<0.05). Azvudine recipients also possessed a lower all-cause mortality rate than controls (2.6797/1000 person-days versus 8.5910/1000 person-days, P<0.01). Azvudine treatment significantly reduced the risk of composite disease progression (HR: 0.37, 95% CI: 0.16-0.84, P=0.017) and all-cause death (HR: 0.25, 95% CI: 0.08-0.81, P=0.021) after adjusting potential confounding factors such as age, sex, severity of COVID-19, complications, concomitant therapy, time from symptoms to treatment, and important laboratory indicators. The subgroup analyses of composite disease progression outcome and all-cause death indicated robustness of Azvudine's in treating COVID-19 patients in general.

Conclusion: Our study demonstrates that Azvudine has a significant positive impact on the clinical recovery of hospitalized patients with COVID-19. These findings provide important support for the use of Azvudine as a therapeutic option for COVID-19, given the current divergent views on its therapeutic efficacy and its importance in public health and medical care.

Keywords: Azvudine; COVID-19; all-cause death; composite disease progression outcome; retrospective cohort study.

Figure 1

Flowchart of patient selection.

Figure 2

Oxygen saturation levels of Azvudine recipients and controls during hospitalization treatment. The Oxygen saturation levels of patients received standard treatment and Azvudine plus standard treatment on the 0, 3, 6, 9, and 12 days after admission for treatment were shown and compared. Day 0 (baseline) represents the first day of admission to hospital.

Figure 3

Incidence of composite disease progression outcome events (A) and separate all-cause death (B) in Azvudine recipients and controls. Day 0 (baseline) represents the first day of admission to hospital.

Figure 4

Subgroups analysis of Azvudine’s effectiveness in reducing risk of all-cause death (A) and composite disease progression outcome events (B) in patients with COVID-19.