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Title

Implementation of raltegravir in routine clinical practice: selection criteria for choosing this drug, virologic response rates, and characteristics of failures

Authors
Scherrer, A. U.
von Wyl, Viktor
Fux, C. A.
Opravil, Milos
Bucher, H. C.
Fayet, Aurelie
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Published in Journal of Acquired Immune Deficiency Syndromes. 2010, vol. 53, no. 4, p. 464-471
Abstract BACKGROUND: Raltegravir (RAL) achieved remarkable virologic suppression rates in randomized-clinical trials, but today efficacy data and factors for treatment failures in a routine clinical care setting are limited. METHODS: First, factors associated with a switch to RAL were identified with a logistic regression including patients from the Swiss HIV Cohort Study with a history of 3 class failure (n = 423). Second, predictors for virologic outcome were identified in an intent-to-treat analysis including all patients who received RAL. Last observation carried forward imputation was used to determine week 24 response rate (HIV-1 RNA >or= 50 copies/mL). RESULTS: The predominant factor associated with a switch to RAL in patients with suppressed baseline RNA was a regimen containing enfuvirtide [odds ratio 41.9 (95% confidence interval: 11.6-151.6)]. Efficacy analysis showed an overall response rate of 80.9% (152/188), whereas 71.8% (84/117) and 95.8% (68/71) showed viral suppression when stratified for detectable and undetectable RNA at baseline, respectively. Overall CD4 cell counts increased significantly by 42 cells/microL (P < 0.001). Characteristics of failures were a genotypic sensitivity score of the background regimen <or=1, very low RAL plasma concentrations, poor adherence, and high viral load at baseline. CONCLUSIONS: Virologic suppression rates in our routine clinical care setting were promising and comparable with data from previously published randomized-controlled trials.
Keywords Anti-HIV Agents/ therapeutic useAntiretroviral Therapy, Highly Active/ methodsCD4 Lymphocyte CountFemaleHIV Infections/ drug therapyHumansMalePyrrolidinones/ therapeutic useRandomized Controlled Trials as TopicTreatment OutcomeViral Load
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PMID: 19841590
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SCHERRER, A. U. et al. Implementation of raltegravir in routine clinical practice: selection criteria for choosing this drug, virologic response rates, and characteristics of failures. In: Journal of Acquired Immune Deficiency Syndromes, 2010, vol. 53, n° 4, p. 464-471. https://archive-ouverte.unige.ch/unige:7574

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Deposited on : 2010-06-21

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