Real-world efficacy of azvudine in high-risk patients with coronavirus disease 2019

Liu Yifeng; Feng Qiming; Zhu Xiaoguang; Tong Yiqing; Zhang Jianming; Zhong Weixi

doi:10.3969/j.issn.1002-1949.2024.07.013

Abstract：Objective To evaluate the efficacy of azvudine in the treatment of high-risk patients with coronavirus disease 2019(COVID-19).Methods The clinical data of patients with CO VID-19 infection who visited the Emergency Department of Shanghai Sixth People's Hospital Affiliated to Shanghai Jiao Tong University School of Medicine from December 8,2022 to January 31,2023 were collected.A total of 379 high-risk patients(age-adjusted Charlson comorbidity index,aCCI≥1 score)were screened and divided into azvudine group(n=221)and other drug group(nirmatrelvir/ritonavir,molnupiravir,n=158)according to the different drugs of antiviral therapy.Confounding factors such as age,gender,body mass index(BMI),and aCCI were set as covariates,with a 1∶1 propensity score matching method employed.The prognosis difference between the two groups were compared after matching to evaluate the efficacy of antiviral therapy with azvudine.The primary prognostic indicator was the 60-day mortality after diagnosis,and the secondary prognostic indicators were hospitalization rate,the rate of severe cases,usage rate of advanced respiratory support,nucleic acid/antigen turning-to-negative time,and relief time of clinical symptom.Results The average age of patients in the azvudine group was younger than that in the other drug groups with a statistically significant difference(years:74.0±12.8 vs.77.1±13.2),and the average aCCI of patients in the azvudine group was lower than that in the other drug groups with a statistically significant difference[scores:4(3,5)vs.4(3,6),P＜0.05].After matching,136 patients were included in each of the two groups.There were no statistically significant differences in age,sex,aCCI,BMI and other confounding factors between the two groups(P＞0.05).Compared with the other drug groups,the azvudine group had a higher hospitalization rate(50.5％vs.80.1％,P＜0.001),a longer nucleic acid/antigen turning-to-negative time(d:7.0 vs.10.0,P=0.003),a longer relief time of clinical symptom(d:11.0 vs.14.0,P=0.019),a lower mortality rate(17.6％vs.8.1％,P=0.019)and a lower usage rate of advanced respiratory support(21.3％vs.11.0％,P=0.021).Logistic regression analysis showed that using azvudine was a protective factor for high-risk CO VID-19 patients in terms of mortality(OR=0.436,P=0.023)and the use of advanced respiratory support(OR=0.457,P=0.023).Conclusions Compared with nirmatrelvir/ritonavir and molnupiravir,azvudine has better clinical effects on reducing the mortality and the usage rate of advanced respiratory support in the treatment of high-risk patients with COVID-19.