Yu Ximiao, Luo Ruiqi, Xie Guijuan, Ji Jiali, Wang Jiehong, Li Xiyue, Qian Xiaojun, Wang Xun
Wuxi School of Medicine, Jiangnan University, Wuxi, Jiangsu Province, People's Republic of China.
Department of Pulmonary and Critical Care Medicine, Jiangnan University Medical Center, Jiangnan University (Wuxi No.2 People's Hospital), Wuxi, Jiangsu Province, People's Republic of China.
Infect Drug Resist. 2024 Sep 14;17:3967-3978. doi: 10.2147/IDR.S477083. eCollection 2024.
This retrospective study aims to compare the effectiveness and safety of four oral antiviral drugs including Simnotrelvir/Ritonavir, Nirmatrelvir/Ritonavir, Azvudine and Molnupiravir in hospitalized patients with Coronavirus Disease 2019 (COVID-19) in a real-world setting, providing evidence to guide clinical practice against COVID-19.
Patients with mild or moderate COVID-19 hospitalized at Wuxi City's Second People's Hospital during December 2022 to June 2023 were included in this study. Patients were grouped by the antiviral drug received. The primary endpoint was the length of hospital stay. Patients were further divided into subgroups for stratified analysis, considering age, timing of medication, and drug mechanisms, to explore whether these factors could influence the treatment efficacy.
Of the enrolled 195 patients receiving any treatment, 42 received Nirmatrelvir/Ritonavir, 33 received Molnupiravir, 81 received Simnotrelvir/Ritonavir, and 39 received Azvudine. Patients in Nirmatrelvir/Ritonavir and Simnotrelvir/Ritonavir groups had significantly shorter hospital stays compared to those in Azvudine group ( < 0.05). No significant difference was observed in hospital stays between those initiating antiviral therapy within or more than five days after symptom onset ( = 0.1109). Among patients with comorbidities, the Nirmatrelvir/Ritonavir and Simnotrelvir/Ritonavir group showed shorter hospital stays than the Azvudine group ( < 0.05). No serious treatment-related adverse events were observed across the groups.
In this retrospective study, Nirmatrelvir/Ritonavir and Simnotrelvir/Ritonavir exerts stronger potency on reducing duration of hospital stays in hospitalized patient with COVID-19, suggestive of a better choice for antiviral therapy. Patients who fail to take antiviral drugs in time after symptom onset would still benefit from these antiviral regimens. Additional well-designed clinical trials with large sample size are still needed to further confirm the effectiveness of these antivirals.
本回顾性研究旨在比较四种口服抗病毒药物，即辛诺特韦/利托那韦、奈玛特韦/利托那韦、阿兹夫定和莫努匹韦，在真实世界环境中对2019冠状病毒病（COVID-19）住院患者的有效性和安全性，为指导抗击COVID-19的临床实践提供证据。
纳入2022年12月至2023年6月期间在无锡市第二人民医院住院的轻度或中度COVID-19患者。患者按接受的抗病毒药物分组。主要终点为住院时间。考虑年龄、用药时间和药物作用机制，将患者进一步分为亚组进行分层分析，以探讨这些因素是否会影响治疗效果。
在纳入的195例接受任何治疗的患者中，42例接受奈玛特韦/利托那韦，33例接受莫努匹韦，81例接受辛诺特韦/利托那韦，39例接受阿兹夫定。奈玛特韦/利托那韦组和辛诺特韦/利托那韦组患者的住院时间明显短于阿兹夫定组（<0.05）。症状出现后5天内或超过5天开始抗病毒治疗的患者住院时间无显著差异（=0.1109）。在合并症患者中，奈玛特韦/利托那韦组和辛诺特韦/利托那韦组的住院时间短于阿兹夫定组（<0.05）。各组均未观察到严重的治疗相关不良事件。
在这项回顾性研究中，奈玛特韦/利托那韦和辛诺特韦/利托那韦在缩短COVID-19住院患者的住院时间方面具有更强的效力，提示其为抗病毒治疗的更好选择。症状出现后未及时服用抗病毒药物的患者仍将从这些抗病毒方案中获益。仍需要额外设计良好的大样本临床试验来进一步证实这些抗病毒药物的有效性。
