Shorter Time to Discontinuation Due to Treatment Failure in People Living with HIV Switched to Dolutegravir Plus Either Rilpivirine or Lamivudine Compared with Integrase Inhibitor-Based Triple Therapy in a Large Spanish Cohort.
Por:
Teira R, Diaz-Cuervo H, Aragao F, Castano M, Romero A, Roca B, Montero M, Galindo M, Munoz-Sanchez M, Espinosa N, Peraire J, Martinez E, De la Fuente B, Domingo P, Deig E, Merino M, Geijo P, Estrada V, Sepulveda M, Garcia J, Berenguer J, Curran A
Publicada:
1 jun 2022
Ahead of Print:
11 abr 2022
Resumen:
INTRODUCTION: Standard therapy for HIV treatment has consisted of two nucleoside analogue reverse transcriptase inhibitors (NRTI) paired with a third agent. Use of two-drug regimens (2DR) has been considered for selected patients in part to avoid toxicities associated with the use of NRTIs. This study aimed to compare the real-world outcomes of integrase inhibitor (INSTI)-based three-drug regimens (3DR) versus 2DR of dolutegravir (DTG) + rilpivirine (RPV) or DTG + lamivudine (3TC). METHODS: All patients in the Spanish VACH cohort switching to INSTI-based 3DR or a 2DR consisting of DTG + RPV or DTG + 3TC between May 2, 2016 and May 15, 2019 were included. Kaplan-Meier curves and Cox proportional hazard models were used to assess time to/risk of discontinuation due to treatment failure (TF) (defined as virologic failure [VF], immunologic failure, or disease progression) and adverse events (AEs). Three secondary analyses were performed: (1) in restricting the analysis to patients who were virologically suppressed (HIV RNA < 50 copies/mL) at switch; (2) matched analysis (2:1, matched by age, sex, number of previous VFs, and line of regimen), and (3) using VF as the primary endpoint in all patients. RESULTS: Overall, 5047 3DR and 617 2DR patients were analyzed. Baseline characteristics differed between groups; 2DR patients were older, more treatment experienced, and more likely to be virologically suppressed at switch. Time to discontinuation due to TF was significantly shorter for 2DR (P = 0.002). The hazard ratio (HR) for discontinuation due to TF on 2DR vs 3DR was 2.33 (P = 0.003). No difference was observed for time to discontinuation (P = 0.908) or risk of discontinuation due to AEs (HR = 0.80; P = 0.488). Results were qualitatively similar in virologically suppressed patients, matched analysis, and for VF. CONCLUSION: In the real world, the risks of discontinuation due to TF and VF were more than two times higher in patients switching to DTG-based 2DR than INSTI-based 3DR, with no difference in discontinuation due to AEs.
Filiaciones:
Teira R:
Hosp Sierrallana, Serv Internal Med, Torrelavega 39300, Spain
Diaz-Cuervo H:
MAOR, Gilead Sci, London, England
Aragao F:
Maple Hlth Grp, New York, NY USA
Unversidade NOVA Lisboa, NOVA Natl Sch Publ Hlth, Publ Hlth Res Ctr, Lisbon, Portugal
Castano M:
Hosp Reg Univ Malaga, Malaga, Spain
Romero A:
Hosp Univ Puerto Real, Puerto Real, Spain
Roca B:
Hosp Gen Castellon, Castellon de La Plana, Spain
Montero M:
Hosp Univ, Valencia, Spain
Politecn La Fe, Valencia, Spain
Galindo M:
Univ Valencia, Hosp Clin, Valencia, Spain
Munoz-Sanchez M:
Hosp Univ Basurto, Bilbao, Spain
Espinosa N:
Hosp Univ Virgen del Rocio, Seville, Spain
Peraire J:
Hosp Univ Joan XXIII, Tarragona, Spain
Martinez E:
Complejo Hosp Albacete, Albacete, Spain
De la Fuente B:
Hosp Univ Cabuenes, Gijon, Spain
Domingo P:
Hosp Al Santa Pau, Barcelona, Spain
Deig E:
Hosp Gen Granollers, Granollers, Spain
Merino M:
Hosp Juan Ramon Jimenez, Huelva, Spain
Geijo P:
Hosp Virgen Luz, Cuenca, Spain
Estrada V:
Hosp Clin San Carlos, Madrid, Spain
Sepulveda M:
Hosp Virgen Salud, Toledo, Spain
Garcia J:
Hosp Santa Lucia, Cartagena, Spain
Berenguer J:
Hosp Gregorio Maranon, Madrid, Spain
Curran A:
Hosp Univ Vall Hebron, Barcelona, Spain
Green Published, gold
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