Paxlovid, azvudine, monoravir, which should I choose?

• Paxlovid (nematevir/ritonavir), commonly known as "P drug";

• Molnupiravir (monopivir, formerly known as "Monupivir"), commonly known as "M drug";

• Azvudine, a domestic new crown drug, commonly known as "A drug";

These three drugs all work directly against the new coronavirus in the body, so what are their similarities and differences?

Without further ado, let's start with a comparison chart:

Image source: Dr.
Lilac Vision Team

Based on the above pros and cons, we have summarized a "new crown antiviral drug selection strategy" for ordinary people:

The new crown antiviral drug is so selected

➊ General elderly (over 60 years old); Smokers, obese

All three can be used, and the effect of "P drug" may be better at present
.
If you have an underlying medical condition, or if you are taking other medications, you need to be evaluated
by a doctor.

➋ Moderate and severe liver and kidney injury

"M drug" is preferred, and the other two may also be available, which needs to be evaluated and decided
by the doctor.

➌ Those who are taking other medications

"M drug" is preferred, but all three need to be evaluated and decided
by a doctor.

➍ Healthy young and middle-aged (under 60 years old)

If lung imaging changes occur, all three can be used
.
Patients with mild disease may not use it, because the effect may be less significant
.

➎ Pregnancy, pregnancy, lactation, children

Pregnancy attempts should be separated from medication, and pregnancy should be avoided within 7 days (P medicine) or 4 days (the other two) of the last dose
.

Pregnancy, lactation, all three are not recommended, please follow the doctor's advice
in special cases.

Children, all three are not recommended
.

➏ Those who have progressed to severe or critical illness

Listen to the doctor's arrangement
.

Note: This section is for informational
purposes only.
All three drugs are prescription drugs that need to be obtained from formal channels and used
under the guidance of a physician.

Next, let's explain in detail what are their characteristics and differences
in terms of "effect", "way of use" and "risk".

The efficacy of the three drugs is not the same

Choose according to the situation

Clinical trials have shown that all three drugs have a certain effect
on the treatment of new coronavirus infection.
However, they may not work the same
way as you think.

According to the current research, the effects of these three drugs can be roughly divided into two categories:

1.
"P Medicine" and "M Medicine"

It can help high-risk new crown infections (especially the elderly and patients with underlying diseases), reduce the risk of severe disease and death, and improve symptoms to a certain extent
.

According to clinical trials, timely administration of "P drug" can reduce the risk of hospitalization and death of new crown in high-risk groups by 89.
1%.

"M drugs" can also reduce the risk of hospitalization and death by about 30%.

However, after marketing, a study conducted in the British population believed that its effect on reducing severe disease and death was not obvious enough, and the effect was still controversial
.

2.
Azvudine

If your new crown is mild, or infected with the lungs but not yet severe, it can help you recover faster and make you more comfortable
.

Azif is scheduled to be approved for the treatment of the new crown in July last year, but clinical trial data is incomplete, and many places need to be further observed and confirmed
.

Existing studies have shown that azvudine can significantly shorten the nucleic acid conversion time of patients with mild and moderate new coronavirus infection, accelerate virus elimination, significantly reduce viral load, reduce patients' symptoms, and shorten the course of
the disease.

Mild (left) and moderate (right) viral load changes in patients with new crown infection, the red line is azvudine, and the blue line is the control group

Image source: References

As for whether azvudine can reduce the risk of severe disease and death like "P drugs" and "M drugs", pharmacologically speaking, this possibility exists, but there are no reliable data
.

In addition, the existing clinical trials of azvudine also have some unsatisfactory aspects, such as too few participants, some groups do not include older people, and the trial design is controversial, etc.
, which need further observation
.

Antiviral drugs are mainly targeted at high-risk groups

It should be taken as soon as possible after infection

The main function of "P drug" and "M drug" is to reduce the risk of
severe disease and death caused by the new crown by suppressing the new crown virus.

Therefore, "P drugs" and "M drugs" are more effective for high-risk groups and should be used as early as possible, as early as possible within the "first 5 days of symptom discovery
".

Criteria for high-risk populations

(Take Paxlovid as an example)

age greater than or equal to 60 years;

Smoking;

overweight or obesity;

Have underlying medical conditions, including diabetes, cardiovascular disease, hypertension, chronic lung disease, chronic kidney disease, cancer, and various medical complex diseases;

immunosuppressive diseases or immunosuppressive treatments, such as AIDS patients, organ transplant recipients;

As long as one of these criteria occupies, it can be considered a high-risk group
.

Azvudine temporarily lacks relevant data, from the pharmacological inference may also follow this medication rule, the sooner the use of the effect, there is "golden 72 hours" clinical experience
.

Antiviral drugs have toxic side effects