Network meta-analysis of post-exposure prophylaxis randomized clinical trials
© 2020 British HIV Association..
OBJECTIVES: We performed a network meta-analysis of PEP randomized clinical trials to evaluate the best regimen.
METHODS: After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three-drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir-boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat-boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non-completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow-up and adverse events.
RESULTS: Participants were mostly men who have sex with men (n = 832, 75%) with non-occupational exposure to HIV (89.86%). Four-hundred fifty-four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non-completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58-1.56; EVG/c: OR 0.65 95% CI 0.30-1.37; RAL: OR 0.68 95% CI 0.41-1.13; and MVC: OR 0.69 95% CI 0.47-1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non-completion at day 28, switching, lost to follow-up or adverse events and MVC for PEP discontinuations due to adverse events.
CONCLUSIONS: Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single-Tablet Regimen.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:22 |
|---|---|
| Enthalten in: |
HIV medicine - 22(2021), 3 vom: 01. März, Seite 218-224 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Fernández, I [VerfasserIn] |
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| Links: |
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| Themen: |
Anti-HIV Agents |
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| Anmerkungen: |
Date Completed 14.03.2022 Date Revised 14.03.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1111/hiv.12964 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM316767433 |
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| 100 | 1 | |a Fernández, I |e verfasserin |4 aut | |
| 245 | 1 | 0 | |a Network meta-analysis of post-exposure prophylaxis randomized clinical trials |
| 264 | 1 | |c 2021 | |
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| 500 | |a Date Completed 14.03.2022 | ||
| 500 | |a Date Revised 14.03.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 British HIV Association. | ||
| 520 | |a OBJECTIVES: We performed a network meta-analysis of PEP randomized clinical trials to evaluate the best regimen | ||
| 520 | |a METHODS: After MEDLINE/Pubmed search, studies were included if: (1) were randomized, (2) comparing at least 2 PEP three-drug regimens and, (3) reported completion rates or discontinuation at 28 days. Five studies with 1105 PEP initiations were included and compared ritonavir-boosted lopinavir (LPV/r) vs. atazanavir (ATV) (one study), cobicistat-boosted elvitegravir (EVG/c) (one study), raltegravir (RAL) (one study) or maraviroc (MVC) (two studies). We estimated the probability of each treatment of being the best based on the evaluation of five outcomes: PEP non-completion at day 28, PEP discontinuation due to adverse events, PEP switching due to any cause, lost to follow-up and adverse events | ||
| 520 | |a RESULTS: Participants were mostly men who have sex with men (n = 832, 75%) with non-occupational exposure to HIV (89.86%). Four-hundred fifty-four (41%) participants failed to complete their PEP course for any reason. The Odds Ratio (OR) for PEP non-completion at day 28 in each antiretroviral compared to LPV/r was: ATV 0.95 (95% CI 0.58-1.56; EVG/c: OR 0.65 95% CI 0.30-1.37; RAL: OR 0.68 95% CI 0.41-1.13; and MVC: OR 0.69 95% CI 0.47-1.01. In addition, the rankogram showed that EVG/c had the highest probability of being the best treatment for the lowest rates in PEP non-completion at day 28, switching, lost to follow-up or adverse events and MVC for PEP discontinuations due to adverse events | ||
| 520 | |a CONCLUSIONS: Our study shows the advantages of integrase inhibitors when used as PEP, particularly EVG as a Single-Tablet Regimen | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Meta-Analysis | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a HIV | |
| 650 | 4 | |a completion | |
| 650 | 4 | |a integrase inhibitors | |
| 650 | 4 | |a post-exposure prophylaxis | |
| 650 | 7 | |a Anti-HIV Agents |2 NLM | |
| 700 | 1 | |a de Lazzari, E |e verfasserin |4 aut | |
| 700 | 1 | |a Inciarte, A |e verfasserin |4 aut | |
| 700 | 1 | |a Diaz-Brito, V |e verfasserin |4 aut | |
| 700 | 1 | |a Milinkovic, A |e verfasserin |4 aut | |
| 700 | 1 | |a Arenas-Pinto, A |e verfasserin |4 aut | |
| 700 | 1 | |a Etcheverrry, F |e verfasserin |4 aut | |
| 700 | 1 | |a García, F |e verfasserin |4 aut | |
| 700 | 1 | |a Leal, L |e verfasserin |4 aut | |
| 700 | 0 | |a HIV-PEP Group |e verfasserin |4 aut | |
| 700 | 1 | |a Fernandez, E |e investigator |4 oth | |
| 700 | 1 | |a Gonzalez, E |e investigator |4 oth | |
| 700 | 1 | |a Lucero, C |e investigator |4 oth | |
| 700 | 1 | |a Leon, A |e investigator |4 oth | |
| 700 | 1 | |a Garcıa, F |e investigator |4 oth | |
| 700 | 1 | |a Manzardo, C |e investigator |4 oth | |
| 700 | 1 | |a Nicolas, D |e investigator |4 oth | |
| 700 | 1 | |a Bodro, M |e investigator |4 oth | |
| 700 | 1 | |a Del Rıo, A |e investigator |4 oth | |
| 700 | 1 | |a Cardozo, C |e investigator |4 oth | |
| 700 | 1 | |a Cervera, C |e investigator |4 oth | |
| 700 | 1 | |a Pericas, J M |e investigator |4 oth | |
| 700 | 1 | |a Sanclemente, G |e investigator |4 oth | |
| 700 | 1 | |a de la Calle, C |e investigator |4 oth | |
| 700 | 1 | |a Morata, L |e investigator |4 oth | |
| 700 | 1 | |a Soriano, A |e investigator |4 oth | |
| 700 | 1 | |a Espinosa, G |e investigator |4 oth | |
| 700 | 1 | |a Blanco, J L |e investigator |4 oth | |
| 700 | 1 | |a Martınez, E |e investigator |4 oth | |
| 700 | 1 | |a Mallolas, J |e investigator |4 oth | |
| 700 | 1 | |a Miró, J |e investigator |4 oth | |
| 700 | 1 | |a Laguno, M |e investigator |4 oth | |
| 700 | 1 | |a Rojas, J |e investigator |4 oth | |
| 700 | 1 | |a Martınez-Rebollar, M |e investigator |4 oth | |
| 700 | 1 | |a Gonzalez-Cordon, A |e investigator |4 oth | |
| 700 | 1 | |a Cervera, C |e investigator |4 oth | |
| 700 | 1 | |a Knobel, H |e investigator |4 oth | |
| 700 | 1 | |a Peraire, J |e investigator |4 oth | |
| 700 | 1 | |a Domingo, P |e investigator |4 oth | |
| 700 | 1 | |a Clotet, B |e investigator |4 oth | |
| 700 | 1 | |a Dalmau, D |e investigator |4 oth | |
| 700 | 1 | |a Cruceta, A |e investigator |4 oth | |
| 700 | 1 | |a Arnaiz, J A |e investigator |4 oth | |
| 700 | 1 | |a Gatell, J M |e investigator |4 oth | |
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