Zhang Ke, Zhang Yang, Liu Xinchao, Li Aixin, Gao Meixia, Hou Jianhua, Guo Chunxiang, Zhang Tong, Wu Hao, Chen Guanzhi, Huang Xiaojie
Department of Dermatology, The Affiliated Hospital of Qingdao University, Qingdao, China.
Center for Infectious Disease, Beijing Youan Hospital, Capital Medical University, Beijing, China.
Front Pharmacol. 2021 Jul 21;12:603068. doi: 10.3389/fphar.2021.603068. eCollection 2021.
The extensive utilisation of antiretroviral therapy has greatly improved the survival rates of those infected with human immunodeficiency virus (HIV). The objective of this study was to compare 3-drug regimens containing non-nucleoside reverse transcriptase inhibitor with 3-drug regimens containing integrase inhibitor (INI) regarding efficacy and safety in treatment-naive HIV-1-infected adults at 48 and 96 weeks, respectively. This study was a network meta-analysis using a Bayesian methodology. On January 8, 2020, we searched databases and other sources for randomized controlled trials conducted in treatment-naive HIV-1 adults and compared multiple 3-drug antiretroviral regimens containing INI, efavirenz (EFV), or rilpivirine (RPV). We extracted data on the following outcomes: virologic suppression, CD4 cell recovery, discontinuations, deaths, adverse events, serious adverse events, deaths related to study drugs, and drug-related adverse events. We conducted calculations within a Bayesian framework using R software. The network contained 15 randomized controlled trials including 9,745 patients. For efficacy outcomes, regimens containing INI, especially dolutegravir (DTG), were generally superior to other regimens. For virologic suppression at 48 weeks, odds ratios (95% credible intervals) were 0.6 (0.43, 0.82) for EFV+ tenofovir disoproxil fumarate (TDF)+emtricitabine (FTC) versus DTG+ abacavir+ lamivudine (3TC) and 0.52 (0.36, 0.75) for EFV+TDF+FTC vs. DTG+TDF+FTC/3TC. For safety outcomes, regimens containing INI tended to be safer relative to regimens without INI. Outcomes associated with death were unsuitable for network meta-analysis due to low event rates. 3-drug regimens containing INI demonstrate better efficacy and safety than those containing RPV or EFV.
抗逆转录病毒疗法的广泛应用极大地提高了人类免疫缺陷病毒(HIV)感染者的生存率。本研究的目的是比较含非核苷类逆转录酶抑制剂的三联疗法与含整合酶抑制剂(INI)的三联疗法分别在初治HIV-1感染成人治疗48周和96周时的疗效和安全性。本研究是一项采用贝叶斯方法的网状荟萃分析。2020年1月8日,我们检索了数据库及其他来源,查找在初治HIV-1成人中开展的随机对照试验,并比较了多种含INI、依非韦伦(EFV)或利匹韦林(RPV)的三联抗逆转录病毒疗法。我们提取了以下结局的数据:病毒学抑制、CD4细胞恢复、停药、死亡、不良事件、严重不良事件、与研究药物相关的死亡以及与药物相关的不良事件。我们使用R软件在贝叶斯框架内进行计算。该网状分析纳入了15项随机对照试验,共9745例患者。在疗效结局方面,含INI的疗法,尤其是多替拉韦(DTG),总体上优于其他疗法。对于48周时的病毒学抑制,EFV+替诺福韦酯(TDF)+恩曲他滨(FTC)对比DTG+阿巴卡韦+拉米夫定(3TC)的比值比(95%可信区间)为0.6(0.43,0.82),EFV+TDF+FTC对比DTG+TDF+FTC/3TC的比值比为0.52(0.36,0.75)。在安全性结局方面,含INI的疗法相对于不含INI的疗法往往更安全。由于事件发生率较低,与死亡相关的结局不适合进行网状荟萃分析。含INI的三联疗法在疗效和安全性方面优于含RPV或EFV的疗法。
N Engl J Med. 2013-11-7
J Acquir Immune Defic Syndr. 2017-12-15
Int J Mol Sci. 2022-12-6
N Engl J Med. 2019-7-24
Epidemiol Health. 2019-4-8
Ann Pharmacother. 2018-8