The effect of monotherapy versus combination antiviral therapy on all-cause mortality risk in COVID-19 patients

This study aimed to determine the effect of Azvudine and Paxlovid on COVID-19 prognosis. A retrospective investigation was conducted on 2,103 hospitalized patients from December 2022 to February 2023 at Shanxi Medical University's First Hospital. Patients were categorized into three groups based on their antiviral treatment: monotherapy, combination therapy, and no treatment. Compared to the control group, both Paxlovid and combination therapy reduced the risk of all-cause mortality (adjusted HR 0.47, 95 % CI 0.27-0.81, P = 0.006 and HR 0.45, 95 % CI 0.24-0.88, P = 0.019, respectively). Subgroup analysis revealed that the association between Azvudine treatment and all-cause mortality risk was significantly stronger in COVID-19 subtypes (interaction P = 0.018), suggesting that the therapeutic effects may be subtype-specific. Therefore, Paxlovid alone reduced mortality risk in moderate and severe cases, while the combination therapy with two antiviral drugs also provided some protection. However, the type-specific impact of Azvudine treatment was notable, with mild cases experiencing significantly better survival rates.