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Comparison of 48‐week efficacies of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide and nucleoside/nucleotide reverse transcriptase inhibitor‐sparing regimens: a systematic review and network meta‐analysis

Gallien, S ; Massetti, M ; Flandre, P ; Leleu, H ; Descamps, D ; Lazaro, E

HIV medicine, 2018-09, Vol.19 (8), p.559-571 [Periódico revisado por pares]

England: Wiley Subscription Services, Inc

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Título:
Comparison of 48‐week efficacies of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide and nucleoside/nucleotide reverse transcriptase inhibitor‐sparing regimens: a systematic review and network meta‐analysis
Autor: Gallien, S ; Massetti, M ; Flandre, P ; Leleu, H ; Descamps, D ; Lazaro, E
Assuntos: Adults ; Antiretroviral agents ; Antiretroviral drugs ; Antiretroviral therapy ; Bayesian analysis ; Clinical trials ; Drug therapy ; drug toxicity ; Effectiveness ; elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide combination ; Emtricitabine ; HIV ; Human immunodeficiency virus ; Identification methods ; Inhibitors ; Life Sciences ; Literature reviews ; Medical research ; Meta-analysis ; network meta‐analysis ; nucleoside reverse transcriptase inhibitor‐sparing regimen ; Nucleosides ; Patients ; Pharmacology ; Protease inhibitors ; Ribonucleic acid ; Ritonavir ; RNA ; RNA-directed DNA polymerase ; Subgroups ; Tenofovir ; Therapy
É parte de: HIV medicine, 2018-09, Vol.19 (8), p.559-571
Descrição: Objectives To compare nucleoside/nucleotide reverse transcriptase inhibitor (NRTI)‐sparing regimens with tenofovir alafenamide (TAF)‐based combinations in HIV‐1‐infected adults, we performed a network meta‐analysis (NMA) to provide estimates of relative efficacy for these two regimens. Methods A systematic literature review (SLR) was performed to identify phase 3/4 randomized controlled clinical trials evaluating the efficacy of commonly used combination antiretroviral therapy (cART) including an NRTI backbone or that of commonly used NRTI‐sparing regimens. A Bayesian random‐effect model was used to compare virological suppression rates at 48 weeks for NRTI‐sparing regimens and elvitegravir/cobicistat/emtricitabine/TAF (E/C/F/TAF). Results Twenty‐three studies in treatment‐naïve patients identified by the SLR were included in the NMA, including four studies assessing NRTI‐sparing regimens. In treatment‐naïve patients, the probability of achieving virological suppression at 48 weeks was between 40% and 60% higher with E/C/F/TAF than with NRTI‐sparing strategies. The credible interval vs. darunavir/ritonavir (DVR/r) + raltegravir (RAL) and LPV/r monotherapy did not include 1. In the subgroup of naïve patients with viral load < 100 000 HIV‐1 RNA copies/mL, a credible difference was found between NRTI‐sparing treatments and E/C/F/TAF. Studies in treatment‐experienced patients were too heterogeneous to allow for an NMA. Conclusions The NMA results suggest that E/C/F/TAF represents a more effective option than NRTI‐sparing regimens in terms of 48‐week efficacy in treatment‐naïve patients. Furthermore, TAF pharmacological properties, as well as tolerability results in clinical studies, suggest a safety profile similar to that of NRTI‐sparing regimens. Thus, the E/C/F/TAF combination might represent a more appropriate option than NRTI‐sparing regimens for initiation of antiretroviral therapy in treatment‐naïve HIV‐infected patients.
Editor: England: Wiley Subscription Services, Inc
Idioma: Inglês

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Comparison of 48‐week efficacies of elvitegravir/cobicistat/emtricitabine/tenofovir alafenamide and nucleoside/nucleotide reverse transcriptase inhibitor‐sparing regimens: a systematic review and network meta‐analysis

Gallien, S ; Massetti, M ; Flandre, P ; Leleu, H ; Descamps, D ; Lazaro, E

England: Wiley Subscription Services, Inc

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