Cambodia reports fourth case of H5N1 avian influenza this year

observation study in e-clinical medicine The authors suggest that the antiviral drugs azvudine and nilmatrevir/ritonavir (paxlobid) were similarly ineffective at preventing death in elderly patients hospitalized with COVID-19 in China; acknowledge that their study results may be influenced by confounding factors and bias.

aZuvudine is conditionally approved in China for the treatment of viral diseases such as COVID-19 and AIDS, but is not approved for use in the United States, and paxlobid is used for the treatment of mild or moderate disease in high-risk adults. It has been approved as a treatment for the new coronavirus infection.

Researchers at the People's Liberation Army General Hospital in Beijing evaluated the electronic medical records of 249 coronavirus patients with an average age of 91.4 years who were admitted in December 2022 and January 2023. Of all patients, 128 received azvudine, 66 received paxlobid, and 55 received azvudine. No antiviral drugs were administered. The average follow-up period was 84 days.

“Older adults have the highest rates of severe illness and death from COVID-19 among all age groups, and older patients commonly have multiple conditions and reuse multiple medications.” the study authors noted, adding that caution is needed. Take it when prescribing the drug to these patients.

Potential confounders, bias

A total of 77 patients (31%) died during follow-up. Neither antiviral drug showed a survival benefit, with Cox analysis of all-cause mortality showing a risk of death of 0.73 in the azvudine group and 0.80 in the paxlobid group compared with no antiviral treatment. It was shown that

The elderly have the highest rates of severe illness and death from COVID-19 among all age groups, and elderly patients commonly have multiple illnesses and reuse multiple medications.

The researchers cited the older participants, chronic disease burden, disease severity, and insufficient study power to detect differences as potential reasons for the lack of clinical benefit.

“Finally, a source of selection bias cannot be excluded, as patients with more severe clinical symptoms may have been preferentially selected by clinicians to receive nilmatrevir/ritonavir,” the researchers wrote. writing. “In that case, outcomes would be expected to be worse for patients receiving nilmatrevir/ritonavir, potentially obscuring the potential therapeutic benefit of nilmatrevir/ritonavir.”

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