Efficacy of Nirmatrelvir-Ritonavir versus Azvudine for COVID-19 Treatment in Tibet: A Retrospective Study

Xiang Zhao; Yuan Cheng; Meng Zhang; Bianba Qianda; Baima Zhouma; Bianba Yangzhen; Yao Zheng; Shuo Zhang; Huiying Zhao

doi:10.2147/IDR.S423725

Efficacy of Nirmatrelvir-Ritonavir versus Azvudine for COVID-19 Treatment in Tibet: A Retrospective Study

Infect Drug Resist. 2023 Sep 11:16:6053-6060. doi: 10.2147/IDR.S423725. eCollection 2023.

Authors

Xiang Zhao¹, Yuan Cheng¹, Meng Zhang¹, Bianba Qianda², Baima Zhouma³, Bianba Yangzhen³, Yao Zheng⁴, Shuo Zhang⁵, Huiying Zhao⁶

Affiliations

¹ Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, People's Republic of China.
² Department of Respiratory and Critical Care Medicine, People's Hospital of Tibet Autonomous Region, Lhasa, People's Republic of China.
³ Department of Tuberculosis, Third People's Hospital of Tibet Autonomous Region, Lhasa, People's Republic of China.
⁴ Departments of Internal Medicine, Affiliated Hospital of Xizang Minzu University, Lhasa, People's Republic of China.
⁵ Department of Emergency Medicine, Peking University First Hospital, Beijing, People's Republic of China.
⁶ Department of Intensive Care Unit, Peking University People's Hospital, Beijing, People's Republic of China.

Abstract

Background: Nirmatrelvir-ritonavir, also known as paxlovid, is a widely used antiviral drug against coronavirus disease 2019 (COVID-19). Azvudine, a drug previously used to treat human immunodeficiency virus-1, has also been used to treat COVID-19 in China. However, only a few clinical studies have evaluated the effects of azvudine. Additionally, studies comparing nirmatrelvir-ritonavir with azvudine have been limited in number.

Methods: We carried out a retrospective case‒control analysis at the Third People's Hospital of the Tibet Autonomous Region. Eighty-two eligible patients with COVID-19 who received azvudine treatment were included. A total of 145 control patients who received nirmatrelvir-ritonavir treatment were selected by propensity score matching for age, sex, the severity of disease, and initial cycle threshold values. A comparison of the nucleic acid test negative conversion time, the length of hospitalization, and mortality rate was conducted.

Results: Overall, the mean nucleic acid test negative conversion time was comparable between the nirmatrelvir-ritonavir and azvudine groups (7.0 [11.0, 15.0] vs 9.0 [6.0, 12.0] days, P=0.064). However, for patients with mild COVID-19, the nucleic acid test negative conversion time was significantly shorter in the nirmatrelvir-ritonavir group than in the azvudine group (6.0 [5.0, 8.0] vs 8.0 [6.0, 11.0] days, P=0.029). The nirmatrelvir-ritonavir group and the azvudine group did not differ significantly in length of hospitalization (8.0 [5.5,10.5] vs 8.0 [5.0,10.0] days, P=0.378). Regarding the mortality rate, there were 4 (2.8%) deaths in the nirmatrelvir-ritonavir group and 3 (3.7%) in the azvudine group (P=0.706).

Conclusion: Azvudine is generally as effective as nirmatrelvir-ritonavir, but for patients with mild COVID-19, nirmatrelvir-ritonavir could suppress the virus more rapidly. For those who cannot be treated with nirmatrelvir-ritonavir, azvudine might be an effective therapy for COVID-19.

Keywords: COVID-19; azvudine; clinical outcome; high altitude; nirmatrelvir-ritonavir.

Grants and funding

This study was supported by the Beijing Natural Science Foundation (L222151), Beijing CSCO Clinical Oncology Research Foundation (Y-HS202202-0073), and Beijing Health Science and Technology Achievements and Appropriate Technology Promotion Project (BHTPP2022085).