Amani Bahman, Amani Behnam
Department of Health Management and Economics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
PLoS One. 2024 Jun 13;19(6):e0298772. doi: 10.1371/journal.pone.0298772. eCollection 2024.
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).
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.
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.
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.
本研究旨在评估阿兹夫定治疗由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）的有效性和安全性。
截至2023年10月20日，在PubMed、Cochrane图书馆、科学网、medRxiv和谷歌学术上进行了检索。使用Cochrane偏倚风险工具评估纳入研究的质量。使用综合Meta分析软件分析数据。
共审查了21项研究，涉及10,011名患者。荟萃分析结果显示，阿兹夫定与标准治疗/安慰剂（SOC/PBO）在死亡率（风险比[RR]=0.48，95%置信区间[CI]：0.40至0.57）和聚合酶链反应（PCR）阴性转换时间（标准平均差=-0.75，95%CI：-1.29至-0.21）方面存在显著差异。然而，两组在住院时间、重症监护病房（ICU）入院率和机械通气需求方面未显示出显著差异（P>0.05）。另一方面，阿兹夫定与奈玛特韦-利托那韦在死亡率（RR=0.73，95%CI：0.58至0.92）、ICU入院率（RR=0.41，95%CI：0.21至0.78）和机械通气需求（RR=0.67，95%CI：0.51至0.89）方面存在显著差异，但两种治疗在PCR阴性转换时间和住院时间方面无显著差异（P>0.05）。组间不良事件发生率无显著差异（P>0.05）。证据的确定性被评为低或中等。
就证据的确定性而言，阿兹夫定对SARS-CoV-2的抗病毒有效性存在疑问。应进一步开展研究以确定阿兹夫定在COVID-19中的有效性和安全性。
