Greenberg, Lauren, Ryom, Lene, Wandeler, Gilles, Grabmeier-Pfistershammer, Katharina, Oellinger, Angela, Neesgaard, Bastian, Stephan, Christoph, Calmy, Alexandra, Rauch, Andri, Castagna, Antonella ORCID: 0000-0002-8338-9714, Spagnuolo, Vincenzo, Johnson, Margaret, Stingone, Christof, Mussini, Cristina, De Wit, Stephane, Necsoi, Coca, Campins, Antoni A., Pradier, Christian, Stecher, Melanie, Wasmuth, Jan-Christian, Monforte, Antonella d'Arminio, Law, Matthew, Puhr, Rainer, Chkhartishvilli, Nikoloz, Tsertsvadze, Tengiz, Garges, Harmony, Thorpe, David, Lundgren, Jens D., Peters, Lars, Bansi-Matharu, Loveleen and Mocroft, Amanda (2020). Uptake and Discontinuation of Integrase Inhibitors (INSTIs) in a Large Cohort Setting. JAIDS, 83 (3). S. 240 - 251. PHILADELPHIA: LIPPINCOTT WILLIAMS & WILKINS. ISSN 1077-9450

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Abstract

Background: Despite increased integrase strand transfer inhibitor (INSTI) use, limited large-scale, real-life data exists on INSTI uptake and discontinuation. Setting: International multicohort collaboration. Methods: RESPOND participants starting dolutegravir (DTG), elvitegravir (EVG), or raltegravir (RAL) after January 1, 2012 were included. Predictors of INSTI used were assessed using multinomial logistic regression. Kaplan-Meier and Cox proportional hazards models describe time to and factors associated with discontinuation. Results: Overall, 9702 persons were included; 5051 (52.1%) starting DTG, 1933 (19.9%) EVG, and 2718 (28.0%) RAL. The likelihood of starting RAL or EVG vs DTG decreased over time and was higher in Eastern and Southern Europe compared with Western Europe. At 6 months after initiation, 8.9% (95% confidence interval: 8.3% to 9.5%) had discontinued the INSTI (6.4% DTG, 7.4% EVG, and 14.0% RAL). The main reason for discontinuation was toxicity (44.2% DTG, 42.5% EVG, 17.3% RAL). Nervous system toxicity accounted for a higher proportion of toxicity discontinuations on DTG (31.8% DTG, 23.4% EVG, 6.6% RAL). Overall, treatment simplification was highest on RAL (2.7% DTG, 1.6% EVG, and 19.8% RAL). Factors associated with a higher discontinuation risk included increasing year of INSTI initiation, female gender, hepatitis C coinfection, and previous non-AIDS-defining malignancies. Individuals in Southern and Eastern Europe were less likely to discontinue. Similar results were seen for discontinuations after 6 months. Conclusions: Uptake of DTG vs EVG or RAL increased over time. Discontinuation within 6 months was mainly due to toxicity; nervous system toxicity was highest on DTG. Discontinuation was highest on RAL, mainly because of treatment simplification.

Item Type: Journal Article
Creators:
CreatorsEmailORCIDORCID Put Code
Greenberg, LaurenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Ryom, LeneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wandeler, GillesUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Grabmeier-Pfistershammer, KatharinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Oellinger, AngelaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Neesgaard, BastianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stephan, ChristophUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Calmy, AlexandraUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Rauch, AndriUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Castagna, AntonellaUNSPECIFIEDorcid.org/0000-0002-8338-9714UNSPECIFIED
Spagnuolo, VincenzoUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Johnson, MargaretUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stingone, ChristofUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mussini, CristinaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
De Wit, StephaneUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Necsoi, CocaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Campins, Antoni A.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Pradier, ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Stecher, MelanieUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Wasmuth, Jan-ChristianUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Monforte, Antonella d'ArminioUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Law, MatthewUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Puhr, RainerUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Chkhartishvilli, NikolozUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Tsertsvadze, TengizUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Garges, HarmonyUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Thorpe, DavidUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Lundgren, Jens D.UNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Peters, LarsUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Bansi-Matharu, LoveleenUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
Mocroft, AmandaUNSPECIFIEDUNSPECIFIEDUNSPECIFIED
URN: urn:nbn:de:hbz:38-342477
DOI: 10.1097/QAI.0000000000002250
Journal or Publication Title: JAIDS
Volume: 83
Number: 3
Page Range: S. 240 - 251
Date: 2020
Publisher: LIPPINCOTT WILLIAMS & WILKINS
Place of Publication: PHILADELPHIA
ISSN: 1077-9450
Language: English
Faculty: Unspecified
Divisions: Unspecified
Subjects: no entry
Uncontrolled Keywords:
KeywordsLanguage
ELVITEGRAVIR/COBICISTAT/EMTRICITABINE/TENOFOVIR DISOPROXIL FUMARATE; ANTIRETROVIRAL-NAIVE ADULTS; CO-FORMULATED ELVITEGRAVIR; BOOSTED PROTEASE INHIBITOR; ONCE-DAILY DOLUTEGRAVIR; HIV-INFECTED PATIENTS; DOUBLE-BLIND; NON-INFERIORITY; INITIAL TREATMENT; ADVERSE EVENTSMultiple languages
Immunology; Infectious DiseasesMultiple languages
URI: http://kups.ub.uni-koeln.de/id/eprint/34247

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