Implementation of Raltegravir in Routine Clinical Practice: Selection Criteria for Choosing This Drug, Virologic Response Rates, and Characteristics of Failures. Journal of acquired immune deficiency syndromes (1999) [J Acquir Immune Defic Syndr] Journal article | | Title | Implementation of Raltegravir in Routine Clinical Practice: Selection Criteria for Choosing This Drug, Virologic Response Rates, and Characteristics of Failures. | | Author(s) | Scherrer AU, von Wyl V, Fux CA, Opravil M, Bucher HC, Fayet A, Decosterd LA, Hirschel B, Khanlari B, Yerly S, Klimkait T, Furrer H, Ledergerber B, Günthard HF, the Swiss HIV Cohort Study | | Institution | From the *Division of Infectious Diseases and Hospital Epidemiology, University Hospital Zürich, University of Zürich, Zürich; daggerDivision of Infectious, Diseases, University Hospital Bern, University of Bern, Bern; double daggerHirslanden Clinic, Schänisweg, Aarau, Switzerland; section signInstitute for Clinical Epidemiology and Biostatistics, University Hospital Basel, University of Basel, Basel; paragraph signDivision of Clinical Pharmacology, University Hospital Lausanne, University Lausanne, Lausanne; parallelDivision of Infectious Diseases, Geneva University Hospital, Geneva; #Division of Infectious Diseases and Hospital Epidemiology, University Hospital, Basel, University Basel, Basel; **Central Laboratory of Virology, Division of Infectious Diseases, Geneva University Hospital and Faculty of Medicine, University of Geneva, Geneva; and daggerdaggerInstitute for Medical Microbiology, University of Basel, Basel, Switzerland. | | Source | J Acquir Immune Defic Syndr 2009 Oct 16. | | 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 < 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/muL (P < 0.001). Characteristics of failures were a genotypic sensitivity score of the background regimen </=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. | | Language | ENG | | Pub Type(s) | JOURNAL ARTICLE
| | PubMed ID | 19841590 |
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