Deng Guangtong, Li Daishi, Sun Yuming, Jin Liping, Zhou Qian, Xiao Chenggen, Wu Qingrong, Sun Huiyan, Dian Yating, Zeng Furong, Pan Pinhua, Shen Minxue
Department of Dermatology, Xiangya Hospital, Central South University, Changsha, China.
National Engineering Research Center of Personalized Diagnostic and Therapeutic Technology, Changsha, China.
J Med Virol. 2023 Apr;95(4):e28756. doi: 10.1002/jmv.28756.
Chinese guidelines prioritize the use of Azvudine and nirmatrelvir-ritonavir in COVID-19 patients. Nevertheless, the real-world effectiveness of Azvudine versus nirmatrelvir-ritonavir is still lacking, despite clinical trials showing their effectiveness compared with matched controls. To compare the effectiveness of Azvudine versus nirmatrelvir-ritonavir treatments in real-world clinical practice, we identified 2118 hospitalized COVID-19 patients, with a follow-up of up to 38 days. After exclusions and propensity score matching, we included 281 Azvudine recipients and 281 nirmatrelvir-ritonavir recipients who did not receive oxygen therapy at admission. The lower crude incidence rate of composite disease progression outcome (7.83 vs. 14.83 per 1000 person-days, p = 0.026) and all-cause death (2.05 vs. 5.78 per 1000 person-days, p = 0.052) were observed among Azvudine recipients. Azvudine was associated with lower risks of composite disease progression outcome (hazard ratio [HR]: 0.55; 95% confidence interval [CI]: 0.32-0.94) and all-cause death (HR: 0.40; 95% CI: 0.16-1.04). In subgroup analyses, the results of composite outcome retained significance among patients aged <65 years, those having a history of disease, those with severe COVID-19 at admission, and those receiving antibiotics. These findings suggest that Azvudine treatment showed effectiveness in hospitalized COVID-19 patients compared with nirmatrelvir-ritonavir in terms of composite disease progression outcome.
中国指南将阿兹夫定和奈玛特韦-利托那韦用于新冠肺炎患者的治疗列为优先选择。然而，尽管临床试验表明阿兹夫定与奈玛特韦-利托那韦相较于配对对照组具有有效性，但在现实世界中，阿兹夫定与奈玛特韦-利托那韦的实际疗效仍缺乏相关研究。为比较阿兹夫定与奈玛特韦-利托那韦在现实临床实践中的治疗效果，我们纳入了2118例住院的新冠肺炎患者，随访时间最长达38天。经过排除和倾向评分匹配后，我们纳入了281例接受阿兹夫定治疗的患者和281例接受奈玛特韦-利托那韦治疗且入院时未接受氧疗的患者。阿兹夫定治疗组的复合疾病进展结局（每1000人日7.83例 vs. 14.83例，p = 0.026）和全因死亡（每1000人日2.05例 vs. 5.78例，p = 0.052）的粗发病率较低。阿兹夫定与较低的复合疾病进展结局风险（风险比[HR]：0.55；95%置信区间[CI]：0.32 - 0.94）和全因死亡风险（HR：0.40；95% CI：0.16 - 1.04）相关。在亚组分析中，复合结局的结果在年龄<65岁的患者、有疾病史的患者、入院时患有重症新冠肺炎的患者以及接受抗生素治疗的患者中保持显著。这些发现表明，在复合疾病进展结局方面，与奈玛特韦-利托那韦相比，阿兹夫定治疗对住院的新冠肺炎患者显示出有效性。
