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In this multicenter, retrospective study, we identified 19763 elderly patients (aged over 60 years) with COVID\u201019 from nine hospitals in Henan Province, China. The primary outcome is all\u2010cause death and the secondary outcome is composite disease progression. After propensity score matching, 4109 Azvudine recipients and 4109 matched controls is included, with average age of 75.15 years. Kaplan\u2013Meier analysis reveales a notably survival and progression\u2010free benefit in Azvudine treatment. The Cox analysis shows that compared with controls, Azvudine recipients have a 33% lower risk of all\u2010cause death (95% confidence Interval (CI): 0.580\u20130.772, p &lt;\u00a00.001), but have no significant difference in composite disease progression (hazard ratio: 0.93, 95% CI: 0.833\u20101.046, p = 0.234). Subgroup analysis suggested Azvudine have a stronger protective effect in patients concomitant with antibiotics. Three sensitive analyses confirm the robustness of the findings. The safety of Azvudine in elderly patients is acceptable. These findings indicate that Azvudine therapy can reduce the rate of all\u2010cause death in hospitalized elderly patients with COVID\u201019, and without obvious adverse events.<\/jats:p>","DOI":"10.1002\/advs.202404450","type":"journal-article","created":{"date-parts":[[2025,2,11]],"date-time":"2025-02-11T09:56:36Z","timestamp":1739267796000},"update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Effectiveness and Safety of Oral Azvudine for Elderly Hospitalized Patients With COVID\u201019: A Multicenter, Retrospective, Real\u2010World Study"],"prefix":"10.1002","volume":"12","author":[{"given":"Ranran","family":"Sun","sequence":"first","affiliation":[{"name":"Department of Infectious Diseases State Key Laboratory of Antiviral Drugs Pingyuan Laboratory The First Affiliated Hospital of Zhengzhou University  Zhengzhou 450052 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