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

Abstract

Xiang Zhao,1 Yuan Cheng,1 Meng Zhang,1 Bianba Qianda,2 Baima Zhouma,3 Bianba Yangzhen,3 Yao Zheng,4 Shuo Zhang,5 Huiying Zhao6 1Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, People’s Republic of China; 2Department of Respiratory and Critical Care Medicine, People’s Hospital of Tibet Autonomous Region, Lhasa, People’s Republic of China; 3Department of Tuberculosis, Third People’s Hospital of Tibet Autonomous Region, Lhasa, People’s Republic of China; 4Departments of Internal Medicine, Affiliated Hospital of Xizang Minzu University, Lhasa, People’s Republic of China; 5Department of Emergency Medicine, Peking University First Hospital, Beijing, People’s Republic of China; 6Department of Intensive Care Unit, Peking University People’s Hospital, Beijing, People’s Republic of ChinaCorrespondence: Yuan Cheng, Department of Respiratory and Critical Care Medicine, Peking University First Hospital, Beijing, 100034, People’s Republic of China, Tel [phone], Fax [phone], Email [email protected]: 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: nirmatrelvir-ritonavir, azvudine, COVID-19, clinical outcome, high altitude

Keywords

• nirmatrelvir-ritonavir
• azvudine
• covid-19
• clinical outcome
• high altitude