Outcomes of two kinds of 3CLpro inhibitors in delayed treatment of COVID-19 patients with diabetes

Background：Anti SARS-Cov-2 drugs within 5 days is definitely effective, but there are still patients who do not receive treatment until 5 days after the symptoms onset. Patients with diabetes are more likely to develop severe/critical COVID-19. There are many anti SARS-CoV-2 drugs in China, but the effect of drugs on diabetes patients 5 days after the COVID-19 symptoms onset is still unclear. Objectives：To explore the outcomes of two kinds of 3CLpro inhibitors in the treatment of diabetes patients with 5 days after COVID-19 symptoms onset. Methods：This retrospective study collected the data of hospitalized patients with diabetes diagnosed with COVID-19 from December 9, 2022 to September 31, 2023. All patients received drug treatment 5 days after COVID-19 symptoms onset of. It includes three cohorts: unused antiviral drugs, nematevir/ritonavir, and lenotevir/ritonavir. Results：A total of 238 hospitalized patients were included, of which 61 patients were treated with Nirmatrelvir/Ritonavir, 69 patients were treated with Simnotrelvir/ritonavir, and the rest were not treated with antiviral drugs. 17 patients died. Among the two types of 3CLpro inhibitors, the use of Nirmatrelvir/Ritonavir showed a significant increase in Glucocorticoids use compared to Simnotrelvir/Ritonavir, and Glucocorticoids use was closely related to poor glycemic control in patients; There was no difference in mortality and fungal infection between Nirmatrelvir/Ritonavir and Simnotrelvir/Ritonavir(fig1). Conclusion：Compared with Nirmatrelvir/ritonavir, Simnotrelvir/ritonavir is more suitable for antiviral treatment of COVID-19 patients with diabetes.