Real-world effectiveness of azvudine versus nirmatrelvir-ritonavir in hospitalized patients with COVID-19 and pre-existing diabetes
Azvudine and nirmatrelvir-ritonavir are prioritized treatments for SARS-CoV-2 infection in China, but their effectiveness and safety in hospitalized patients with COVID-19 and pre-existing diabetes remains unknown. In this retrospective cohort study, we collected 32,864 hospitalized COVID-19 patients from nine hospitals, among which 636 azvudine recipients and 318 nirmatrelvir-ritonavir recipients were enrolled for final analysis after exclusion and propensity score matching. Kaplan-Meier and multivariate Cox regression analysis results showed that azvudine had a lower risk of all-cause death compared with nirmatrelvir-ritonavir for the treatment of patients with COVID-19 and pre-existing diabetes (log rank: <i>p</i> = 0.044; HR: 0.63; 95% CI: 0.431-0.934). No significant difference was found in composite disease progression between the two groups. Five sensitivity analyses verified the robustness of the results. Overall, azvudine may be comparable to nirmatrelvir-ritonavir in terms of both all-cause death and composite disease progression among hospitalized patients with COVID-19 and pre-existing diabetes, with acceptable adverse events.
Authors
- Guotao Li (ORCID: https://orcid.org/0000-0001-9201-2700)
- Zhigang Ren (ORCID: https://orcid.org/0000-0003-0798-3444)
- Yanyang Zhang (ORCID: https://orcid.org/0000-0003-0611-4781)
- Guanyue Su (ORCID: https://orcid.org/0000-0002-4067-0696)
- Ling Wang (ORCID: https://orcid.org/0000-0002-9775-7805)
- Guowu Qian
- Ming Cheng (ORCID: https://orcid.org/0000-0001-7098-6790)
- Hong Luo (ORCID: https://orcid.org/0000-0002-9501-651X)
- Donghua Zhang (ORCID: https://orcid.org/0000-0003-2959-9638)
- Shixi Zhang (ORCID: https://orcid.org/0000-0001-6649-622X)
- Guangming Li (ORCID: https://orcid.org/0000-0002-0281-8258)
- Zujiang Yu (ORCID: https://orcid.org/0000-0003-0954-5472)
- Yiqiang Yuan (ORCID: https://orcid.org/0000-0002-1585-9200)
- Na Han (ORCID: https://orcid.org/0000-0001-6987-2956)
- Yongjian Zhou (ORCID: https://orcid.org/0000-0002-4036-4592)
- Silin Li (ORCID: https://orcid.org/0000-0002-4543-1141)
- Jiyuan Xing (ORCID: https://orcid.org/0000-0001-5432-7074)
- Zhan Song
- Mengzhao Yang
Institutions
- Zhengzhou University (CN)
- People’s Hospital of Wenshan Prefecture (CN)
- The Fifth People's Hospital of Anyang (CN)
- Shangqiu First People's Hospital (CN)
- Second Affiliated Hospital of Zhengzhou University (CN)
- Nanyang Institute of Technology (CN)
- Luoyang Central Hospital Affiliated to Zhengzhou University (CN)
- The People's Hospital of LinXia (CN)
- Henan Provincial Chest Hospital (CN)
- The Sixth People's Hospital of Zhengzhou (CN)
- First Affiliated Hospital of Zhengzhou University (CN)
- Henan Provincial Center for Disease Control and Prevention (CN)
Publication Details
- Journal
- iScience
- Published
- 2025-01-27
- DOI
- https://doi.org/10.1016/j.isci.2025.111907
- Citations
- 2
- Primary Topic
- Neonatal Health and Biochemistry
- Type
- article
- Field-Weighted Citation Impact
- 6.99
Funders
- Zhengzhou University
- First Affiliated Hospital of Zhengzhou University
- National Key Research and Development Program of China