Department of Infectious Diseases, Saint-Louis Hospital, Assistance Publique Hôpitaux de Paris.
University of Paris Diderot Paris 7, Paris, France.
Curr Opin HIV AIDS. 2018 Jul;13(4):308-314. doi: 10.1097/COH.0000000000000471.
The current review addresses the role of doravirine (DOR), a novel once-daily nonnucleoside reverse transcriptase inhibitor (NNRTI) in first-line therapy at a time in which multiple options are available, and issues of antiviral efficacy, safety, simplicity and cost are critical to make informed decisions.
DOR combination regimens have been tested in two large randomized double-blinded clinical trials in treatment-naïve patients, showing noninferiority to ritonavir-boosted darunavir-based and efavirenz (EFV)-based regimens. The main features of DOR are reviewed in this report including its antiviral activity, genetic barrier to resistance, safety, once-daily dosing and coformulation in a single tablet with tenofovir disoproxil fumarate and lamivudine. DOR pharmacokinetics and drug-drug interactions are also reviewed as DOR can be given without food restriction and has no interaction with proton pump inhibitors. DOR has shown a superior safety profile than EFV regarding neuropsychiatric and cutaneous adverse events. DOR is currently being investigated in treatment-experienced patients and in those with transmitted NNRTI drug resistance.
DOR is a promising new NNRTI that could become the preferred drug in its class for treatment initiation. DOR has shown excellent antiviral activity in treatment-naïve patients, a better safety profile than EFV and a low potential for drug-drug interactions.
目前的综述探讨了多伟拉林（DOR）在多种选择的情况下，作为一线治疗药物的作用，其抗病毒疗效、安全性、简单性和成本问题对于做出明智决策至关重要。
在两项针对初治患者的大型随机双盲临床试验中，已经测试了 DOR 联合治疗方案，结果显示与利托那韦增效的达芦那韦和依非韦伦（EFV）为基础的方案相当。本文综述了 DOR 的主要特征，包括其抗病毒活性、耐药性遗传屏障、安全性、每日一次给药以及与富马酸替诺福韦二吡呋酯和拉米夫定联合制成的单片制剂。还综述了 DOR 的药代动力学和药物相互作用，因为 DOR 可以不受食物限制给药，并且与质子泵抑制剂无相互作用。与 EFV 相比，DOR 在神经精神和皮肤不良事件方面具有更好的安全性。目前正在对治疗经验丰富的患者和具有传播性 NNRTI 耐药性的患者进行 DOR 的研究。
DOR 是一种很有前途的新型 NNRTI，可能成为该类药物治疗的首选药物。DOR 在初治患者中表现出了极好的抗病毒活性，比 EFV 具有更好的安全性，并且药物相互作用的潜力较低。
