Clinical use, efficacy, and durability of maraviroc for antiretroviral therapy in routine care: A European survey

• Published in: PloS one 2019-11, Vol.14 (11), p.e0225381
• Main Authors: De Luca, Andrea, Pezzotti, Patrizio, Boucher, Charles, Döring, Matthias, Incardona, Francesca, Kaiser, Rolf, Lengauer, Thomas, Pfeifer, Nico, Schülter, Eugen, Vandamme, Anne-Mieke, Zazzi, Maurizio, Geretti, Anna Maria
• Format: Article
• Language: English
• Subjects: Acquired immune deficiency syndrome; Adult; AIDS; Anti-HIV Agents - pharmacology; Anti-HIV Agents - therapeutic use; Antimicrobial agents; Antiretroviral agents; Antiretroviral drugs; Antiretroviral therapy; Biological products industry; Biology and Life Sciences; CD4 antigen; Clinical medicine; Confidence intervals; Dosage; Drug resistance; Drug therapy; Drugs; Durability; Enfuvirtide; Failure analysis; Female; Highly active antiretroviral therapy; HIV; HIV Infections - drug therapy; HIV Infections - epidemiology; HIV Infections - virology; HIV-1 - drug effects; Human immunodeficiency virus; Humans; Ibalizumab; Infections; Informatics; Male; Maraviroc; Maraviroc - pharmacology; Maraviroc - therapeutic use; Medicine and Health Sciences; Microbial Sensitivity Tests; Middle Aged; Patients; People and Places; Polls & surveys; Protease inhibitors; Proteinase inhibitors; Public Health Surveillance; Regression analysis; Statistical analysis; Studies; Systematic review; Transaminase; Treatment Failure; Treatment Outcome; Tropism; Viral Load; Viral Tropism; Virology; Viruses
• ISSN: 1932-6203; 1932-6203
• DOI: 10.1371/journal.pone.0225381

The study aimed to survey maraviroc use and assess effectiveness and durability of maraviroc-containing antiretroviral treatment (ART) in routine practice across Europe. Data were retrieved from 26 cohorts in 8 countries comprising adults who started maraviroc in 2005-2016 and had ≥1 follow-up visit. Available V3 sequences were re-analysed centrally for tropism determination by geno2pheno[coreceptor]. Treatment failure (TF) was defined as either virological failure (viral load >50 copies/mL) or maraviroc discontinuation for any reason over 48 weeks. Predictors of TF were explored by logistic regression analysis. Time to maraviroc discontinuation was estimated by Kaplan-Meier survival analysis. At maraviroc initiation (baseline), among 1,381 patients, 67.1% had experienced ≥3 ART classes and 45.6% had a viral load 50 copies/mL in 19.9% and >200 copies/mL in 10.7%. Independent predictors of TF comprised a low nadir CD4 count, a detectable baseline viral load, previous PI experience, non-R5 tropism, having ≥3 active drugs in the accompanying regimen, and a more recent calendar year of maraviroc initiation. This study reports on the largest observation cohort of patients who started maraviroc across 8 European countries. In this overall highly treatment-experienced population, with a small but appreciable subset that received maraviroc outside of standard treatment guidelines, maraviroc was safe and reasonably effective, with relatively low rates of discontinuation over 48 weeks and only 2 cases of serum transaminase elevations reported as reasons for discontinuation.