The influence of patient beliefs and treatment satisfaction on the discontinuation of current first‐line antiretroviral regimens

Casado, José L.; Marín, Ana; Romero, Vivian; Bañón, Sara; Moreno, Ana; Pérez-Elías, MJ; Moreno, Santiago; Rodriguez-Sagrado, MA

doi:10.1111/hiv.12280

Cited by 11 publications

(13 citation statements)

References 42 publications

(47 reference statements)

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“…Converging evidence suggests that the occurrence of unwanted adverse events during drug treatment is in part determined by nonpharmacological effects [17]. On the patient's side, it has been shown that beliefs and satisfaction with therapy modulate the impact of mild AEs on the discontinuation of antiretroviral regimens [18]. Nonpharmacological effects may explain our findings as well as the large differences in the ‘real-world’ reported to date for DTG.…”

Section: Discussionmentioning

confidence: 70%

Short-Term Neuropsychiatric Tolerability of Bictegravir Combined with Emtricitabine/Tenofovir Alafenamide in Clinical Practice

et al. 2019

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Background Neuropsychiatric AEs (NPAEs) leading to dolutegravir (DTG) discontinuation were seen more frequently in real-world use than in randomized clinical trials (RCTs). The recently approved fixed-dose combination bictegravir plus emtricitabine and tenofovir alafenamide (BIC/F/TAF) has shown comparable NPAE rates but some favourable patient-reported outcomes in RCTs compared with DTG. We were interested in its neuropsychiatric tolerability in clinical practice. Methods All patients starting BIC/F/TAF from June 2018 in a single centre (two subcentres) were followed retrospectively. Discontinuation rates due to any AEs and NPAEs were compared with those of patients initiating DTG-based regimens. Results As of May 2019, a total of 943 patients (852 males, 76 females, 15 transgender and gender diverse) initiated BIC/F/TAF outside RCTs. After a median follow-up of 6.2 months, 50 (5.3%) and 31 (3.3%) patients had discontinued BIC/F/TAF due to any AEs or to NPAEs, respectively. In multivariate analysis, a pre-existing depression and subcentre remained predictive for NPAEs, but not age, gender, ethnicity or prior DTG-related AEs. Compared with 1,043 patients treated with DTG-based regimens, the estimated NPAE-related discontinuation rate with BIC/F/TAF was comparable during the first 6 months (P=0.36). Cross-intolerance was low, and only 5/55 patients with prior DTG intolerability had to discontinue BIC/F/TAF due to NPAEs. Conclusions Short-term tolerability of BIC/F/TAF was comparable to DTG-containing regimens. As seen with DTG, discontinuation rates were higher than in RCTs. A pre-existing depression but also physician's awareness may have an impact on tolerability and continuation of BIC/F/TAF. In contrast, prior intolerability of DTG was of limited predictive value.

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Section: Discussionmentioning

confidence: 70%

Short-Term Neuropsychiatric Tolerability of Bictegravir Combined with Emtricitabine/Tenofovir Alafenamide in Clinical Practice

et al. 2019

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“…It has been shown that patients' beliefs and satisfaction with therapy modulate the impact of mild AEs . However, in most patients (including women and older patients) who discontinued dolutegravir, the subsequent ART regime was well tolerated.…”

Section: Discussionmentioning

confidence: 99%

Higher rates of neuropsychiatric adverse events leading to dolutegravir discontinuation in women and older patients

et al. 2016

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Objectives Dolutegravir (DTG), a second-generation integrase strand transfer inhibitor (INSTI), is now among the most frequently used antiretroviral agents. However, recent reports have raised concerns about potential neurotoxicity. MethodsWe performed a retrospective analysis of a cohort of HIV-infected patients who had initiated an INSTI in two large German out-patient clinics between 2007 and 2016. We compared discontinuation rates because of adverse events (AEs) within 2 years of starting treatment with dolutegravir, raltegravir or elvitegravir/cobicistat. We also evaluated factors associated with dolutegravir discontinuation. ResultsA total of 1950 INSTI-based therapies were initiated in 1704 patients eligible for analysis within the observation period. The estimated rates of any AE and of neuropsychiatric AEs leading to discontinuation within 12 months were 7.6% and 5.6%, respectively, for dolutegravir (n = 985), 7.6% and 0.7%, respectively, for elvitegravir (n = 287), and 3.3% and 1.9%, respectively, for raltegravir (n = 678). Neuropsychiatric AEs leading to dolutegravir discontinuation were observed more frequently in women [hazard ratio (HR) 2.64; 95% confidence interval (CI) 1.23-5.65; P = 0.012], in patients older than 60 years (HR: 2.86; 95% CI: 1.42-5.77; P = 0.003) and in human leucocyte antigen (HLA)-B*5701-negative patients who initiated abacavir at the same time (HR: 2.42; 95% CI: 1.38-4.24; P = 0.002). ConclusionsIn this large cohort, the rate of discontinuation of dolutegravir because of neuropsychiatric adverse events was significantly higher than for other INSTIs, at almost 6% within 12 months. Despite the limitations of this retrospective study, the almost three-fold higher discontinuation rates observed amongst women and older patients underscore the need for further investigation, especially in patient populations usually underrepresented in clinical trials.

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“…These results are reassuring for the long-term efficacy of the single tablet regimen as there is an association between satisfaction of HIV-infected patients with their treatment and compliance with cART [19,20]. We cannot exclude perception bias as patients' perception, even before switching, and personal beliefs can modulate and influence the perceived efficacy of new treatment, health improvement, and adverse events, translating into higher satisfaction with the new therapy [21]. Our results are in accordance with those of the randomized STRIVIING study, where virologically suppressed patients who switched for abacavir/lamivudine/dolutegravir were more satisfied with their treatment at week 24 compared with patients who did not change treatment [12].…”

Section: Discussionmentioning

confidence: 91%

Switching from abacavir/lamivudine plus nevirapine to abacavir/lamivudine/dolutegravir in virologically controlled HIV-infected adults (SWAD study)

Allavena

Volteau

André-Garnier

et al. 2019

Médecine et Maladies Infectieuses

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The influence of patient beliefs and treatment satisfaction on the discontinuation of current first‐line antiretroviral regimens

Abstract: Patients' beliefs and satisfaction with therapy influence the durability of the first antiretroviral regimen. These patient-related factors modulate the impact of mild adverse events, and could explain differences in the rate of discontinuation.

Cited by 11 publications

References 42 publications

Short-Term Neuropsychiatric Tolerability of Bictegravir Combined with Emtricitabine/Tenofovir Alafenamide in Clinical Practice

Short-Term Neuropsychiatric Tolerability of Bictegravir Combined with Emtricitabine/Tenofovir Alafenamide in Clinical Practice

Higher rates of neuropsychiatric adverse events leading to dolutegravir discontinuation in women and older patients

Switching from abacavir/lamivudine plus nevirapine to abacavir/lamivudine/dolutegravir in virologically controlled HIV-infected adults (SWAD study)

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