Impact of early and delayed azvudine administration on COVID-19 mortality: a retrospective study

Azvudine is recommended for patients with coronavirus disease 19 (COVID-19); however, its optimum therapeutic time window and its impact on mortality of patients are unclear. This single-centre, retrospective study from 1 November 2022 to 27 February 2023 conducted at the Peking Union Medical College Hospital was to discuss the dosing window of azvudine and compare the prognostic impact on COVID-19 patients of azvudine use within and after the defined time window. Therapeutic time window referred to the time interval between the onset of the disease and the drug administration. 28-day all-cause mortality and the incidence of 28-day disease progression were assessed using univariate logistic regression and adjusted for covariates through multivariate logistic regression analysis. A total of 421 COVID-19 patients using azvudine and 720 patients not using any anti-SARS-CoV-2 drugs were enrolled. After propensity score matching, 302 patients treated with azvudine and 302 patients without antiviral drugs were included. Multivariate logistic regression analysis showed that the use of azvudine was significantly protective until 8 days of symptom onset for COVID-19 patients. Compared with the latter, treatment with azvudine reduced the all-cause mortality rate (OR 0.55, 95% CI 0.30-1.00) and disease progression rate (OR 0.52, 95% CI 0.29-0.93) to 28 days. The study indicated that the benefit of azvudine seemed more significant within 8 days of symptoms onset and the administration of azvudine reduced the risk of death in adult COVID-19 patients. In the future, large randomized controlled trials (RCT) studies are needed to confirm our conclusions because of the inherent limitation of single-centre, retrospective study.