Department of Critical Care Medicine, West China Hospital of Sichuan University, Chengdu, People's Republic of China.
Department of Cardiac Vascular Surgery Critical Care Medicine, The Third People's Hospital of Chengdu, Chengdu, People's Republic of China.
BMJ Open Respir Res. 2024 Apr 10;11(1):e001944. doi: 10.1136/bmjresp-2023-001944.
In China, both nirmatrelvir-ritonavir (Paxlovid) and azvudine have been granted approval to treat adult SARS-CoV-2-infected patients with moderate symptoms. Information about the clinical effect of the two available agents among inpatients with severe or critical COVID-19 is scarce.
To compare the clinical outcomes of Paxlovid and azvudine among adult inpatients with severe or critical COVID-19.
We conducted a retrospective cohort study in two large medical centres after the epidemic control measures were lifted in China. A new propensity score matched-inverse probability of treatment weighting cohort was constructed to evaluate the in-hospital all-cause mortality, hospital length of stay, Sequential Organ Failure Assessment (SOFA) score and safety.
A total of 955 individuals were in the cohort. The antiviral therapy strategies were decided by the senior physician and the supplies of the pharmacy. A total of 451 patients were in the Paxlovid group, and 504 patients were in the azvudine group. Compared with Paxlovid, the effects of azvudine on in-hospital all-cause mortality were not significantly different, and the OR (95% CI) was 1.084 (0.822 to 1.430), and the average hospital length of stay of patients discharged alive was also similar in the azvudine group, and the difference (day) and (95% CI) was 0.530 (-0.334 to 1.393). After 7 days of therapy, the degree of decline in the SOFA score was greater in the Paxlovid group than in the azvudine group (p<0.001). The change in glomerular filtration rate was not significantly different (p=0.824).
Paxlovid and azvudine had similar effectiveness on in-hospital all-cause mortality and hospital length of stay. Compared with the azvudine group, after 7 days of therapy, the degree of decline in SOFA score was significantly higher in the Paxlovid group. These findings need to be verified in larger prospective studies or randomised controlled trials.
在中国，尼马曲韦/利托那韦（Paxlovid）和阿兹夫定已被批准用于治疗有中度症状的成人 SARS-CoV-2 感染患者。关于住院的严重或危重新冠肺炎患者中这两种现有药物的临床效果的信息很少。
比较 Paxlovid 和阿兹夫定在住院的严重或危重新冠肺炎成人患者中的临床结局。
在中国疫情防控措施解除后，我们在两家大型医疗机构进行了一项回顾性队列研究。构建了新的倾向评分匹配逆概率治疗加权队列，以评估住院全因死亡率、住院时间、序贯器官衰竭评估（SOFA）评分和安全性。
共有 955 人纳入队列。抗病毒治疗策略由资深医生和药房供应决定。共有 451 名患者接受 Paxlovid 治疗，504 名患者接受阿兹夫定治疗。与 Paxlovid 相比，阿兹夫定对住院全因死亡率的影响无显著差异，OR（95%CI）为 1.084（0.822 至 1.430），且存活出院患者的平均住院时间也相似，差异（天）和（95%CI）为 0.530（-0.334 至 1.393）。治疗 7 天后，Paxlovid 组患者 SOFA 评分下降程度大于阿兹夫定组（p<0.001）。肾小球滤过率的变化无显著差异（p=0.824）。
Paxlovid 和阿兹夫定在住院全因死亡率和住院时间方面具有相似的疗效。与阿兹夫定组相比，治疗 7 天后，Paxlovid 组患者 SOFA 评分下降程度显著更高。这些发现需要在更大的前瞻性研究或随机对照试验中验证。
