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Efficacy and safety of contemporary dual-drug antiretroviral regimens as first-line treatment or as a simplification strategy: a systematic review and meta-analysis.
- Source :
-
The lancet. HIV [Lancet HIV] 2016 Aug; Vol. 3 (8), pp. e351-e360. Date of Electronic Publication: 2016 May 31. - Publication Year :
- 2016
-
Abstract
- Background: Some guidelines recommended two-drug antiretroviral therapies as alternative regimens to triple therapy in selected patients with the aim of reducing drug burden and toxicity and preserving future treatment options. We aimed to assess the efficacy and safety of dual-therapy versus triple therapy as first-line treatment or in treatment simplification.<br />Methods: For this systematic review and meta-analysis, we searched Medline, Embase (via OVID), the Cochrane Trial Registry, and major conference proceedings for randomised trials published between Jan 1, 2008, and Dec 31, 2015. We included studies comparing dual-therapy (from two independent classes) antiretroviral regimens as a first-line or a switch strategy (in virologically suppressed individuals) with standard triple-drug regimens. Our primary outcome was the risk of virological failure (non-completion=failure) at the 48 week timepoint. We did a random-effect meta-analysis to pool the relative risk (RR) or odds ratio (OR) for each of the outcomes.<br />Findings: For the primary outcome, we included 21 studies (11 first-line and ten switch studies), providing data for 4821 individuals (2478 in dual-therapy groups and 2343 in control groups). Overall, the RR of failure with dual-therapy compared with triple-therapy (control) groups was 1·14 (95% CI 0·91-1·43). In first-line studies, the RR of failure for dual-therapy versus control groups was 1·17 (0·94-1·47; I(2)=51%), which reduced to 1·05 (0·86-1·28; I(2)=26%) on exclusion of maraviroc-containing studies. In switch studies, the RR of failure for dual-therapy versus control groups was 1·21 (0·72-2·02; I(2)=67%), which reduced to 1·13 (0·64-1·99; I(2)=61%) after exclusion of maraviroc-containing studies. In patients with a baseline viral load of more than 100 000 copies per mL, RR of failure for dual-therapy versus control groups was 1·24 (1·03-1·49), which reduced to 1·18 (0·94-1·47) on excluding maraviroc-containing studies. We recorded the ORs for dual-therapy versus control groups for serious adverse events (1·16 [0·92-1·48]), adverse events (0·82 [0·52-1·28]), and mutations (2·11 [1·32-3·36]).<br />Interpretation: Dual therapy, especially with regimens excluding maraviroc, could be safe and efficacious, particularly in patients with baseline viral loads of less than 100 000 copies per mL. However, dual therapy seems to have a greater risk of selecting resistance mutations compared with standard triple therapy.<br />Funding: None.<br /> (Copyright © 2016 Elsevier Ltd. All rights reserved.)
- Subjects :
- Anti-HIV Agents therapeutic use
Cyclohexanes administration & dosage
Cyclohexanes adverse effects
Cyclohexanes therapeutic use
Drug Therapy, Combination adverse effects
HIV Infections virology
HIV-1 drug effects
Humans
Lamivudine administration & dosage
Lamivudine adverse effects
Lamivudine therapeutic use
Male
Maraviroc
Middle Aged
Odds Ratio
Reverse Transcriptase Inhibitors adverse effects
Reverse Transcriptase Inhibitors therapeutic use
Risk
Triazoles administration & dosage
Triazoles adverse effects
Triazoles therapeutic use
Viral Load
Anti-HIV Agents administration & dosage
HIV Infections drug therapy
Reverse Transcriptase Inhibitors administration & dosage
Subjects
Details
- Language :
- English
- ISSN :
- 2352-3018
- Volume :
- 3
- Issue :
- 8
- Database :
- MEDLINE
- Journal :
- The lancet. HIV
- Publication Type :
- Academic Journal
- Accession number :
- 27470027
- Full Text :
- https://doi.org/10.1016/S2352-3018(16)30015-7