Durability of first-line regimens including integrase strand transfer inhibitors (INSTIs): data from a real-life setting.

d'Arminio Monforte, A; Cozzi-Lepri, A; Di Biagio, A; Marchetti, G; Cacopardo, B; Lo Caputo, S; Rusconi, S; Gianotti, N; Mazzotta, V; Mazzarello, G; Costantini, A; Castagna, A; ICONA Foundation Study, Group.

doi:10.1093/jac/dky566

Objectives: To evaluate the durability of three integrase strand transfer inhibitors (INSTIs) and two NRTIs in ARTnaive individuals. Methods: The study design was observational. Patients were HIV-positive, ART-naive subjects starting raltegravir, elvitegravir/cobicistat or dolutegravir with two NRTIs. The primary endpoint was time to treatment failure, i.e. occurrence of virological failure (first of two consecutive plasma HIV RNAs 200 copies/mL after 24 weeks) or INSTI discontinuation for any reason apart from simplification. Secondary endpoints were INSTI discontinuation due to toxicity/intolerance and CD4 count response. Survival analysis was done using Kaplan–Meier and Cox regression. Results: Two thousand and sixteen patients were included: 310 (15.4%) started raltegravir-based regimens, 994 (49.3%) started dolutegravir-based regimens and 712 (35.3%) started elvitegravir/cobicistat-based regimens. Over a median of 11 months, 167 patients experienced treatment failure; the 1 year probability of treatment failure was 6.5% for raltegravir, 5.4% for dolutegravir and 6.7% for elvitegravir/cobicistat (P " 0.001). Sixty-eight patients (3.4%) discontinued INSTIs owing to toxicity/intolerance. By multivariable analysis, patients starting raltegravir had a 2.03-fold (95% CI" 1.2–3.2) higher risk and patients on elvitegravir/cobicistat a 1.88- fold (95% CI" 1.2–2.9) higher risk of treatment failure versus dolutegravir; there was no difference in risk of discontinuation due to toxicity/intolerance when comparing dolutegravir and raltegravir and marginal evidence for a difference when comparing elvitegravir/cobicistat and dolutegravir (adjusted relative hazard" 1.94 for elvitegravir/cobicistat versus dolutegravir, 95% CI" 1.00–3.76, P " 0.05). Conclusions: In our real-life setting, INSTI-based regimens showed high potency and durability. Among regimens currently recommended in Europe, those including dolutegravir are associated with a lower risk of treatment failure.

Titolo:	Durability of first-line regimens including integrase strand transfer inhibitors (INSTIs): data from a real-life setting.
Autori interni:	d'Arminio Monforte A Cozzi-Lepri A Di Biagio A Marchetti G CACOPARDO, Bruno Santi Lo Caputo S Rusconi S Gianotti N Mazzotta V Mazzarello G Costantini A Castagna A ICONA Foundation Study Group. mostra contributor esterni nascondi contributor esterni
Data di pubblicazione:	2019
Rivista:	JOURNAL OF ANTIMICROBIAL CHEMOTHERAPY
Handle:	http://hdl.handle.net/20.500.11769/361181
Appare nelle tipologie:	1.1 Articolo in rivista

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