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A comparison of the long‐term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study
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 nevirapi...
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| Published in: | HIV medicine 2011-05, Vol.12 (5), p.259-268 |
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| container_end_page | 268 |
| container_issue | 5 |
| container_start_page | 259 |
| container_title | HIV medicine |
| container_volume | 12 |
| creator | Reekie, J Reiss, P Ledergerber, B Sedlacek, D Parczewski, M Gatell, J Katlama, C Fätkenheuer, G Lundgren, JD Mocroft, A |
| description | 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 |
| doi_str_mv | 10.1111/j.1468-1293.2010.00877.x |
| format | article |
| fullrecord | <record><control><sourceid>wiley_pubme</sourceid><recordid>TN_cdi_pubmed_primary_20812948</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>HIV877</sourcerecordid><originalsourceid>FETCH-LOGICAL-c3687-c7e978df1d0ab46bcda557608a529d7a26b3a25e3153a3779323dd5667bda1893</originalsourceid><addsrcrecordid>eNo9kE1OwzAQhS0EoqVwBeQDkOCfxk4Qm6oUWqkSC3621iR2wVWaRE4CLSvWrDgjJ8FpobOZ5_feePEhhCkJqZ_LZUiHIg4oS3jIiHcJiaUM1weovw8Ot3oYMCFYD53U9ZIQKnlCjlGPkdhXhnEffY1wVq4qcLYuC1wucPNqcF4WLz-f341xK6xbB6nNbbPp0sK8WQeVLcwFNgvwD1N8YCi0v_FuZ2BbYFe2je_gLLeFzSDHlYOssZnpwknryspcYdiqh9nNCNdNqzen6GgBeW3O_vYAPd1OHsfTYH5_NxuP5kHGRSyDTJpExnpBNYF0KNJMQxRJQWKIWKIlMJFyYJHhNOLApUw441pHQshUA40TPkDnu3-rNl0ZrSpnV-A26h-KL1zvCu82N5t9Tonq4Kul6hirjrHq4KstfLVW09mzF_wXLXF6bg</addsrcrecordid><sourcetype>Index Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype></control><display><type>article</type><title>A comparison of the long‐term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study</title><source>Wiley-Blackwell Read & Publish Collection</source><creator>Reekie, J ; Reiss, P ; Ledergerber, B ; Sedlacek, D ; Parczewski, M ; Gatell, J ; Katlama, C ; Fätkenheuer, G ; Lundgren, JD ; Mocroft, A</creator><creatorcontrib>Reekie, J ; Reiss, P ; Ledergerber, B ; Sedlacek, D ; Parczewski, M ; Gatell, J ; Katlama, C ; Fätkenheuer, G ; Lundgren, JD ; Mocroft, A ; EuroSIDA study group</creatorcontrib><description>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.</description><identifier>ISSN: 1464-2662</identifier><identifier>EISSN: 1468-1293</identifier><identifier>DOI: 10.1111/j.1468-1293.2010.00877.x</identifier><identifier>PMID: 20812948</identifier><language>eng</language><publisher>Oxford, UK: Blackwell Publishing Ltd</publisher><subject>antiviral therapy ; Argentina - epidemiology ; Benzoxazines - adverse effects ; Benzoxazines - therapeutic use ; Drug Administration Schedule ; Drug Resistance ; Drug Therapy, Combination ; durability ; Europe - epidemiology ; Female ; HIV Infections - drug therapy ; HIV Infections - epidemiology ; HIV Infections - virology ; HIV Protease Inhibitors - therapeutic use ; HIV-1 ; Humans ; Israel - epidemiology ; long‐term adverse events ; Lopinavir ; Male ; Nevirapine - adverse effects ; Nevirapine - therapeutic use ; Prospective Studies ; Pyrimidinones - adverse effects ; Pyrimidinones - therapeutic use ; Reverse Transcriptase Inhibitors - therapeutic use ; Treatment Outcome ; Viral Load</subject><ispartof>HIV medicine, 2011-05, Vol.12 (5), p.259-268</ispartof><rights>2010 British HIV Association</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c3687-c7e978df1d0ab46bcda557608a529d7a26b3a25e3153a3779323dd5667bda1893</citedby></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/20812948$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Reekie, J</creatorcontrib><creatorcontrib>Reiss, P</creatorcontrib><creatorcontrib>Ledergerber, B</creatorcontrib><creatorcontrib>Sedlacek, D</creatorcontrib><creatorcontrib>Parczewski, M</creatorcontrib><creatorcontrib>Gatell, J</creatorcontrib><creatorcontrib>Katlama, C</creatorcontrib><creatorcontrib>Fätkenheuer, G</creatorcontrib><creatorcontrib>Lundgren, JD</creatorcontrib><creatorcontrib>Mocroft, A</creatorcontrib><creatorcontrib>EuroSIDA study group</creatorcontrib><title>A comparison of the long‐term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study</title><title>HIV medicine</title><addtitle>HIV Med</addtitle><description>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.</description><subject>antiviral therapy</subject><subject>Argentina - epidemiology</subject><subject>Benzoxazines - adverse effects</subject><subject>Benzoxazines - therapeutic use</subject><subject>Drug Administration Schedule</subject><subject>Drug Resistance</subject><subject>Drug Therapy, Combination</subject><subject>durability</subject><subject>Europe - epidemiology</subject><subject>Female</subject><subject>HIV Infections - drug therapy</subject><subject>HIV Infections - epidemiology</subject><subject>HIV Infections - virology</subject><subject>HIV Protease Inhibitors - therapeutic use</subject><subject>HIV-1</subject><subject>Humans</subject><subject>Israel - epidemiology</subject><subject>long‐term adverse events</subject><subject>Lopinavir</subject><subject>Male</subject><subject>Nevirapine - adverse effects</subject><subject>Nevirapine - therapeutic use</subject><subject>Prospective Studies</subject><subject>Pyrimidinones - adverse effects</subject><subject>Pyrimidinones - therapeutic use</subject><subject>Reverse Transcriptase Inhibitors - therapeutic use</subject><subject>Treatment Outcome</subject><subject>Viral Load</subject><issn>1464-2662</issn><issn>1468-1293</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2011</creationdate><recordtype>article</recordtype><recordid>eNo9kE1OwzAQhS0EoqVwBeQDkOCfxk4Qm6oUWqkSC3621iR2wVWaRE4CLSvWrDgjJ8FpobOZ5_feePEhhCkJqZ_LZUiHIg4oS3jIiHcJiaUM1weovw8Ot3oYMCFYD53U9ZIQKnlCjlGPkdhXhnEffY1wVq4qcLYuC1wucPNqcF4WLz-f341xK6xbB6nNbbPp0sK8WQeVLcwFNgvwD1N8YCi0v_FuZ2BbYFe2je_gLLeFzSDHlYOssZnpwknryspcYdiqh9nNCNdNqzen6GgBeW3O_vYAPd1OHsfTYH5_NxuP5kHGRSyDTJpExnpBNYF0KNJMQxRJQWKIWKIlMJFyYJHhNOLApUw441pHQshUA40TPkDnu3-rNl0ZrSpnV-A26h-KL1zvCu82N5t9Tonq4Kul6hirjrHq4KstfLVW09mzF_wXLXF6bg</recordid><startdate>201105</startdate><enddate>201105</enddate><creator>Reekie, J</creator><creator>Reiss, P</creator><creator>Ledergerber, B</creator><creator>Sedlacek, D</creator><creator>Parczewski, M</creator><creator>Gatell, J</creator><creator>Katlama, C</creator><creator>Fätkenheuer, G</creator><creator>Lundgren, JD</creator><creator>Mocroft, A</creator><general>Blackwell Publishing Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope></search><sort><creationdate>201105</creationdate><title>A comparison of the long‐term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study</title><author>Reekie, J ; Reiss, P ; Ledergerber, B ; Sedlacek, D ; Parczewski, M ; Gatell, J ; Katlama, C ; Fätkenheuer, G ; Lundgren, JD ; Mocroft, A</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c3687-c7e978df1d0ab46bcda557608a529d7a26b3a25e3153a3779323dd5667bda1893</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2011</creationdate><topic>antiviral therapy</topic><topic>Argentina - epidemiology</topic><topic>Benzoxazines - adverse effects</topic><topic>Benzoxazines - therapeutic use</topic><topic>Drug Administration Schedule</topic><topic>Drug Resistance</topic><topic>Drug Therapy, Combination</topic><topic>durability</topic><topic>Europe - epidemiology</topic><topic>Female</topic><topic>HIV Infections - drug therapy</topic><topic>HIV Infections - epidemiology</topic><topic>HIV Infections - virology</topic><topic>HIV Protease Inhibitors - therapeutic use</topic><topic>HIV-1</topic><topic>Humans</topic><topic>Israel - epidemiology</topic><topic>long‐term adverse events</topic><topic>Lopinavir</topic><topic>Male</topic><topic>Nevirapine - adverse effects</topic><topic>Nevirapine - therapeutic use</topic><topic>Prospective Studies</topic><topic>Pyrimidinones - adverse effects</topic><topic>Pyrimidinones - therapeutic use</topic><topic>Reverse Transcriptase Inhibitors - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Viral Load</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Reekie, J</creatorcontrib><creatorcontrib>Reiss, P</creatorcontrib><creatorcontrib>Ledergerber, B</creatorcontrib><creatorcontrib>Sedlacek, D</creatorcontrib><creatorcontrib>Parczewski, M</creatorcontrib><creatorcontrib>Gatell, J</creatorcontrib><creatorcontrib>Katlama, C</creatorcontrib><creatorcontrib>Fätkenheuer, G</creatorcontrib><creatorcontrib>Lundgren, JD</creatorcontrib><creatorcontrib>Mocroft, A</creatorcontrib><creatorcontrib>EuroSIDA study group</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><jtitle>HIV medicine</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Reekie, J</au><au>Reiss, P</au><au>Ledergerber, B</au><au>Sedlacek, D</au><au>Parczewski, M</au><au>Gatell, J</au><au>Katlama, C</au><au>Fätkenheuer, G</au><au>Lundgren, JD</au><au>Mocroft, A</au><aucorp>EuroSIDA study group</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>A comparison of the long‐term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study</atitle><jtitle>HIV medicine</jtitle><addtitle>HIV Med</addtitle><date>2011-05</date><risdate>2011</risdate><volume>12</volume><issue>5</issue><spage>259</spage><epage>268</epage><pages>259-268</pages><issn>1464-2662</issn><eissn>1468-1293</eissn><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.</abstract><cop>Oxford, UK</cop><pub>Blackwell Publishing Ltd</pub><pmid>20812948</pmid><doi>10.1111/j.1468-1293.2010.00877.x</doi><tpages>10</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | HIV medicine, 2011-05, Vol.12 (5), p.259-268 |
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| subjects | antiviral therapy Argentina - epidemiology Benzoxazines - adverse effects Benzoxazines - therapeutic use Drug Administration Schedule Drug Resistance Drug Therapy, Combination durability Europe - epidemiology Female HIV Infections - drug therapy HIV Infections - epidemiology HIV Infections - virology HIV Protease Inhibitors - therapeutic use HIV-1 Humans Israel - epidemiology long‐term adverse events Lopinavir Male Nevirapine - adverse effects Nevirapine - therapeutic use Prospective Studies Pyrimidinones - adverse effects Pyrimidinones - therapeutic use Reverse Transcriptase Inhibitors - therapeutic use Treatment Outcome Viral Load |
| title | A comparison of the long‐term durability of nevirapine, efavirenz and lopinavir in routine clinical practice in Europe: a EuroSIDA study |
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