A comparison of the long-term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study
J Reekie, P Reiss, B Ledergerber, D Sedlacek, M Parczewski, J Gatell, C Katlama, G Fätkenheuer, J D Lundgren, A Mocroft, EuroSIDA study group, M Losso, C Elias, N Vetter, R Zangerle, I Karpov, A Vassilenko, V M Mitsura, O Suetnov, N Clumeck, S De Wit, M Delforge, R Colebunders, L Vandekerckhove, V Hadziosmanovic, K Kostov, J Begovac, L Machala, H Rozsypal, D Sedlacek, J Nielsen, G Kronborg, T Benfield, M Larsen, J Gerstoft, T Katzenstein, A-B E Hansen, P Skinhøj, C Pedersen, O D Larsen, L Oestergaard, K Zilmer, Jelena Smidt, M Ristola, C Katlama, J-P Viard, P-M Girard, J M Livrozet, P Vanhems, C Pradier, F Dabis, D Neau, J Rockstroh, R Schmidt, J van Lunzen, O Degen, H J Stellbrink, S Staszewski, J Bogner, G Fätkenheuer, J Kosmidis, P Gargalianos, G Xylomenos, J Perdios, G Panos, A Filandras, E Karabatsaki, H Sambatakou, D Banhegyi, F Mulcahy, I Yust, D Turner, M Burke, S Pollack, G Hassoun, S Maayan, A Chiesi, R Esposito, I Mazeu, C Mussini, C Arici, R Pristera, F Mazzotta, A Gabbuti, V Vullo, M Lichtner, A Chirianni, E Montesarchio, M Gargiulo, G Antonucci, F Iacomi, P Narciso, C Vlassi, M Zaccarelli, A Lazzarin, R Finazzi, M Galli, A Ridolfo, A d Arminio Monforte, B Rozentale, I Zeltina, S Chaplinskas, R Hemmer, T Staub, P Reiss, J Bruun, A Maeland, V Ormaasen, B Knysz, J Gasiorowski, A Horban, E Bakowska, A Grzeszczuk, R Flisiak, A Boron-Kaczmarska, M Pynka, M Parczewski, M Beniowski, E Mularska, H Trocha, E Jablonowska, E Malolepsza, K Wojcik, F Antunes, E Valadas, K Mansinho, F Maltez, D Duiculescu, A Rakhmanova, E Vinogradova, S Buzunova, D Jevtovic, M Mokrá, D Staneková, J Tomazic, J González-Lahoz, V Soriano, P Labarga, J Medrano, S Moreno, B Clotet, A Jou, R Paredes, C Tural, J Puig, I Bravo, J M Gatell, J M Miró, P Domingo, M Gutierrez, G Mateo, M A Sambeat, A Karlsson, L Flamholc, B Ledergerber, R Weber, P Francioli, M Cavassini, B Hirschel, E Boffi, H Furrer, M Battegay, L Elzi, E Kravchenko, N Chentsova, G Kutsyna, S Servitskiy, S Antoniak, M Krasnov, S Barton, A M Johnson, D Mercey, A Phillips, M A Johnson, A Mocroft, M Murphy, J Weber, G Scullard, M Fisher, C Leen, B Clotet, R Paredes, F Antunes, B Clotet, D Duiculescu, J Gatell, B Gazzard, A Horban, A Karlsson, C Katlama, B Ledergerber, A D Arminio Montforte, A Phillips, A Rakhmanova, P Reiss, J Rockstroh, J Lundgren, O Kirk, A Mocroft, N Friis-Møller, A Cozzi-Lepri, W Bannister, M Ellefson, A Borch, D Podlekareva, J Kjær, L Peters, J Reekie, J Kowalska, J Reekie, P Reiss, B Ledergerber, D Sedlacek, M Parczewski, J Gatell, C Katlama, G Fätkenheuer, J D Lundgren, A Mocroft, EuroSIDA study group, M Losso, C Elias, N Vetter, R Zangerle, I Karpov, A Vassilenko, V M Mitsura, O Suetnov, N Clumeck, S De Wit, M Delforge, R Colebunders, L Vandekerckhove, V Hadziosmanovic, K Kostov, J Begovac, L Machala, H Rozsypal, D Sedlacek, J Nielsen, G Kronborg, T Benfield, M Larsen, J Gerstoft, T Katzenstein, A-B E Hansen, P Skinhøj, C Pedersen, O D Larsen, L Oestergaard, K Zilmer, Jelena Smidt, M Ristola, C Katlama, J-P Viard, P-M Girard, J M Livrozet, P Vanhems, C Pradier, F Dabis, D Neau, J Rockstroh, R Schmidt, J van Lunzen, O Degen, H J Stellbrink, S Staszewski, J Bogner, G Fätkenheuer, J Kosmidis, P Gargalianos, G Xylomenos, J Perdios, G Panos, A Filandras, E Karabatsaki, H Sambatakou, D Banhegyi, F Mulcahy, I Yust, D Turner, M Burke, S Pollack, G Hassoun, S Maayan, A Chiesi, R Esposito, I Mazeu, C Mussini, C Arici, R Pristera, F Mazzotta, A Gabbuti, V Vullo, M Lichtner, A Chirianni, E Montesarchio, M Gargiulo, G Antonucci, F Iacomi, P Narciso, C Vlassi, M Zaccarelli, A Lazzarin, R Finazzi, M Galli, A Ridolfo, A d Arminio Monforte, B Rozentale, I Zeltina, S Chaplinskas, R Hemmer, T Staub, P Reiss, J Bruun, A Maeland, V Ormaasen, B Knysz, J Gasiorowski, A Horban, E Bakowska, A Grzeszczuk, R Flisiak, A Boron-Kaczmarska, M Pynka, M Parczewski, M Beniowski, E Mularska, H Trocha, E Jablonowska, E Malolepsza, K Wojcik, F Antunes, E Valadas, K Mansinho, F Maltez, D Duiculescu, A Rakhmanova, E Vinogradova, S Buzunova, D Jevtovic, M Mokrá, D Staneková, J Tomazic, J González-Lahoz, V Soriano, P Labarga, J Medrano, S Moreno, B Clotet, A Jou, R Paredes, C Tural, J Puig, I Bravo, J M Gatell, J M Miró, P Domingo, M Gutierrez, G Mateo, M A Sambeat, A Karlsson, L Flamholc, B Ledergerber, R Weber, P Francioli, M Cavassini, B Hirschel, E Boffi, H Furrer, M Battegay, L Elzi, E Kravchenko, N Chentsova, G Kutsyna, S Servitskiy, S Antoniak, M Krasnov, S Barton, A M Johnson, D Mercey, A Phillips, M A Johnson, A Mocroft, M Murphy, J Weber, G Scullard, M Fisher, C Leen, B Clotet, R Paredes, F Antunes, B Clotet, D Duiculescu, J Gatell, B Gazzard, A Horban, A Karlsson, C Katlama, B Ledergerber, A D Arminio Montforte, A Phillips, A Rakhmanova, P Reiss, J Rockstroh, J Lundgren, O Kirk, A Mocroft, N Friis-Møller, A Cozzi-Lepri, W Bannister, M Ellefson, A Borch, D Podlekareva, J Kjær, L Peters, J Reekie, J Kowalska
Abstract
Objectives: The durability of combination antiretroviral therapy (cART) regimens can be measured as time to discontinuation because of toxicity or treatment failure, development of clinical disease or serious long-term adverse events. The aim of this analysis was to compare the durability of nevirapine, efavirenz and lopinavir regimens based on these measures.
Methods: Patients starting a nevirapine, efavirenz or lopinavir-based cART regimen for the first time after 1 January 2000 were included in the analysis. Follow-up started ≥ 3 months after initiation of treatment if viral load was <500 HIV-1 RNA copies/mL. Durability was measured as discontinuation rate or development/worsening of clinical markers.
Results: A total of 603 patients (21%) started nevirapine-based cART, 1465 (51%) efavirenz, and 818 (28%) lopinavir. After adjustment there was no significant difference in the risk of discontinuation for any reason between the groups on nevirapine and efavirenz (P=0.43) or lopinavir (P=0.13). Compared with the nevirapine group, those on efavirenz had a 48% (P=0.0002) and those on lopinavir a 63% (P<0.0001) lower risk of discontinuation because of treatment failure and a 31% (P=0.01) and 66% (P<.0001) higher risk, respectively, of discontinuation because of toxicities or patient/physician choice. There were no significant differences in the incidence of non-AIDS-related events, worsening anaemia, severe weight loss, increased aspartate aminotransferase (AST)/alanine aminotransferase (ALT) levels or increased total cholesterol. Compared with patients on nevirapine, those on lopinavir had an 80% higher incidence of high-density lipoprotein (HDL) cholesterol decreasing below 0.9 mmol/L (P=0.003), but there was no significant difference in this variable between those on nevirapine and those on efavirenz (P=0.39).
Conclusions: The long-term durability of nevirapine-based cART, based on risk of all-cause discontinuation and development of long-term adverse events, was comparable to that of efavirenz or lopinavir, in patients in routine clinical practice across Europe who initially tolerated and virologically responded to their regimen.
Source: PubMed