Rilpivirine vs. efavirenz-based single-tablet regimens in treatment-naive adults

Abstract

In treatment-naive, HIV-1-infected participants, 96-week RPV/FTC/TDF treatment demonstrated noninferior efficacy and better tolerability than EFV/FTC/TDF.

First‐line antiretroviral therapy with efavirenz plus tenofovir disiproxil fumarate/emtricitabine or rilpivirine plus tenofovir disiproxil fumarate/emtricitabine: a durability comparison

“…Also, because of the recognized efficacy of this drug, EFV has been frequently used as the comparator treatment in randomized controlled efficacy trials [26]. RPV has been more recently introduced into clinical practice and it has been studied in comparative trials only vs. EFV, in both STRs [16] and regimens that are not co-formulated [27][28][29]; and all these studies consistently showed a higher tolerability of RPV-based regimens [27][28][29], and even a greater virological potency in the setting of HIV RNA < 100 000 copies/mL and CD4 count > 200 cells/lL [16]. The data from the ICONA cohort document that the proportion of people starting first-line RPV-based regimens has increased in recent years, while use of EFV has declined.…”

“…caused by these imbalances is improbable. RPV is a preferred option in many guidelines as a first-line agent [3,4,7,31], has low costs, the lowest risk of rash among NNRTI-based therapies, and a low risk of metabolic adverse effects, in addition to being co-formulated in the smallest tablet among single-pill regimens [5,32] and showing lower relative risks for neurological events than EFV [16,32]. RPV has also been previously reported to be more durable compared not only with EFV, but also with other modern drugs including an INSTI [i.e.…”

“…However, people with baseline HIV RNA > 100 000 copies/mL were not excluded in these other studies. Moreover, in a recent meta-analysis including four randomized controlled trials with EFV as the comparator, RPV was noninferior at 48 and 96 weeks for the endpoint of viral suppression ≤ 50 copies/mL [16,32] and showed no difference in terms of CD4 count change from baseline [16,32], but a higher risk of virological failure [32].…”

“…Many studies have compared the short-and long-term efficacies and tolerabilities of the two different singletablet regimen (STR), NNRTI-based cART strategies [13,[16][17][18], but few data are available on the durability of EFV and RPV, the only NNRTIs formulated as STRs [16]. Only two published studies have specifically assessed RPV durability, both concluding that RPV had a significantly better performance in cART-na€ ıve patients compared with other antiretroviral agents [19,20].…”

Real-World Assessment of Renal and Bone Safety among Patients with HIV Infection Exposed to Tenofovir Disoproxil Fumarate-Containing Single-Tablet Regimens

“…In a study comparing RPV/FTC/TDF vs EFV/FTC/TDF, renal safety findings up to 96 weeks were similar across both regimens; 1 patient discontinued due to renal failure with RPV/FTC/TDF and 2 patients discontinued due to renal adverse events with EFV/FTC/TDF, (1 due to renal failure and 1 due to proteinuria and hypoproteinemia) [27]. In a study comparing EVG/COBI/FTC/TDF vs, EFV/FTC/TDF, renal safety findings up to 144 weeks appeared to favor EFV/FTC/TDF; 2.2% of patients discontinued due to renal adverse events with EVG/COBI/FTC/TDF (renal failure, Fanconi syndrome, increased serum creatinine, and abnormal glomerular filtration rate), whereas no patients discontinued due to renal adverse events with EFV/FTC/TDF [28].…”