Efficacy and safety of switching lamivudine-based dual therapies for the maintenance of virologic suppression in adults with HIV-1: a systematic review and network meta-analysis

Abstract

Background：Based on available evidence, lamivudine-based dual therapies have been found to be effective, safe, and non-inferior to triple treatment in HIV-1 infected patients who are virologically suppressed. Because these dual therapies have fewer side effects and improved patient compliance. However, further comparisons of the efficacy and safety are still lacking among different lamivudine-based dual therapies. This study systematically assessed the efficacy and safety of switching to various lamivudine-based dual therapies. Methods: We searched the eligible randomized controlled trials (RCTs) from electronic databases as followed: ScienceDirect, MEDLINE, EMBASE, Web of Science, Pubmed, U.S.National Library of Medicine (www.clinicaltrials.gov). Data were analyzed by network meta-analysis using the network package in Stata 15.0. On the basis of the SUCRA scores, cluster analysis was performed to evaluate the efficacy and safety of the interventions and determine the optimal therapies. Results: A total of 7 randomized controlled trials (RCTs) involving 2539 patients were included in this study. The network meta-analysis results of different dual therapies based on lamivudine revealed that the increase in CD4 cell count from baseline was significantly higher in patients treated with DTG + 3TC compared to TT (MD=17.97, 95% CI:0.41, 35.54). However, no significant differences were observed in any other comparisons. Compared with TT alone, ATV + 3TC had the highest probability of maintaining virologic suppression, improving CD4 cell count from baseline and reducing the adverse events incidence. LPV + 3TC had the lowest rate of serious adverse events and withdrawal due to adverse events. According to the cluster analysis results, ATV + 3TC and DTG + 3TC might be the best choice concerning efficacy and safety simultaneously. Conclusions: According to the data analysis, compared to triple treatment, lamivudine-based dual therapies might be the more favorable option in patients with an HIV-1 infection who were virologically suppressed. Among the lamivudine-based dual therapies, ATV + 3TC and DTG + 3TC might be the most favorable options for the maintenance of virologic suppression in adults with HIV-1. Meta registration: The study protocol was registered in PROSPERO (CRD 42023387562).