Comparative efficacy, tolerability and safety of dolutegravir and efavirenz 400mg among antiretroviral therapies for first-line HIV treatment: A systematic literature review and network meta-analysis.
Comparative efficacy, tolerability and safety of dolutegravir and efavirenz 400mg among antiretroviral therapies for first-line HIV treatment: A systematic literature review and network meta-analysis.
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DOI：
10.1016/j.eclinm.2020.100573
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发表时间：
2020-11
影响因子：
15.1
通讯作者：
Bansback N
中科院分区：
文献类型：
--
作者：
Kanters S;Vitoria M;Zoratti M;Doherty M;Penazzato M;Rangaraj A;Ford N;Thorlund K;Anis PAH;Karim ME;Mofenson L;Zash R;Calmy A;Kredo T;Bansback N
为了告知世界卫生组织（WHO）的全球指南，我们更新并扩大了证据基础，以评估一线抗逆转录病毒治疗（ART）方案的比较疗效，耐受性和安全性。我们于2020年2月28日检索了Embase、Medline和CENTRAL，以更新比较推荐的一线ART的临床试验的系统性文献综述，这些临床试验为之前的WHO指南提供了信息。结局包括病毒抑制、CD 4细胞计数变化、死亡率、严重和总体不良事件（AE）、停药、因AE而停药（DAE）;以及新结局：耐药性、神经精神AE、早期病毒抑制、体重增加和出生结局。通过网络荟萃分析评估比较效果，并使用GRADE框架评估证据的确定性。我们确定了156篇出版物，涉及68项针对主要人群的试验。相对于依法韦仑，度鲁特韦在所有时间点的病毒抑制几率均有所改善（96周时比值比[OR]：1.94; 95%可信区间[CrI]：1.48 - 2.56）;对耐药性具有保护作用（OR：0.13; 95%CrI：0.04 ~ 0.48）;停药次数较少（OR：0.58; 95%CrI：0.48 ~ 0.70）。证据支持结核-艾滋病毒合并感染者和孕妇使用度鲁特韦。在33.2%的度鲁特韦管理妊娠和35.0%的依法韦仑管理妊娠中观察到不良出生结局。低剂量依法韦仑的疗效和安全性与标准剂量依法韦仑相当，但导致的DAE较少（OR：0.70; 95%CrI：0.50 - 0.92）。证据支持选择度鲁特韦联合拉米夫定/恩曲他滨和富马酸替诺福韦酯作为首选的一线治疗方案，低剂量依法韦仑为基础的治疗方案作为替代方案。可以认为多鲁特韦是有效、安全和可耐受的。WHO.
To inform World Health Organization (WHO) global guidelines, we updated and expanded the evidence base to assess the comparative efficacy, tolerability, and safety of first-line antiretroviral therapy (ART) regimens. We searched Embase, Medline and CENTRAL on 28 February 2020 to update the systematic literature review of clinical trials comparing recommended first-line ART that informed previous WHO guidelines. Outcomes included viral suppression, change in CD4 cell counts, mortality, serious and overall adverse events (AEs), discontinuation, discontinuations due to AEs (DAEs); and new outcomes: drug-resistance, neuropsychiatric AEs, early viral suppression, weight gain and birth outcomes. Comparative effects were assessed through network meta-analyses and certainty in the evidence was assessed using the GRADE framework. We identified 156 publications pertaining to 68 trials for the primary population. Relative to efavirenz, dolutegravir had improved odds of viral suppression across all time points (odds ratio [OR]: 1·94; 95% credible interval [CrI]: 1·48–2·56 at 96 weeks); was protective of drug-resistance (OR: 0·13; 95%CrI: 0·04–0·48); and led to fewer discontinuations (OR: 0·58; 95%CrI: 0·48–0·70). Evidence supported dolutegravir use among TB-HIV co-infected persons and pregnant women. Adverse birth outcomes were observed in 33.2% of dolutegravir-managed pregnancies and 35.0% of efavirenz-managed pregnancies. Low-dose efavirenz had comparable efficacy and safety to standard-dose efavirenz, but led to fewer DAEs (OR: 0·70; 95%CrI: 0·50–0·92). The evidence supports choosing dolutegravir in combination with lamivudine/emtricitabine and tenofovir disoproxil fumarate as the preferred first-line regimen and low-dose efavirenz-based regimens as an alternative. Dolutegravir can be considered to be effective, safe and tolerable. WHO.
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影响因子：
7.2
作者：
Guyatt, Gordon H.;Oxman, Andrew D.;Schuenemann, Holger J.
通讯作者：
Schuenemann, Holger J.
DOI：
10.1056/nejmoa1600693
发表时间：
2016-09-01
期刊：
The New England journal of medicine
影响因子：
--
作者：
Cohen MS;Chen YQ;McCauley M;Gamble T;Hosseinipour MC;Kumarasamy N;Hakim JG;Kumwenda J;Grinsztejn B;Pilotto JH;Godbole SV;Chariyalertsak S;Santos BR;Mayer KH;Hoffman IF;Eshleman SH;Piwowar-Manning E;Cottle L;Zhang XC;Makhema J;Mills LA;Panchia R;Faesen S;Eron J;Gallant J;Havlir D;Swindells S;Elharrar V;Burns D;Taha TE;Nielsen-Saines K;Celentano DD;Essex M;Hudelson SE;Redd AD;Fleming TR;HPTN 052 Study Team
通讯作者：
HPTN 052 Study Team
影响因子：
82.9
作者：
Long, Quan-Xin;Liu, Bai-Zhong;Huang, Ai-Long
通讯作者：
Huang, Ai-Long
影响因子：
168.9
作者：
Gilks, Charles F.;Crowley, Siobhan;De Cock, Kevin
通讯作者：
De Cock, Kevin
影响因子：
56.3
作者：
Amin, Janaki;Becker, Stephen;Dolan, Matthew
通讯作者：
Dolan, Matthew