کد مقاله کد نشریه سال انتشار مقاله انگلیسی نسخه تمام متن
5821894 1557823 2015 5 صفحه PDF دانلود رایگان
عنوان انگلیسی مقاله ISI
Safety, efficacy and indications of prescription of maraviroc in clinical practice: Factors associated with clinical outcomes
ترجمه فارسی عنوان
ایمنی، کارآیی و نشانه های تجویز مارانوکر در عمل بالینی: عوامل مرتبط با نتایج بالینی
موضوعات مرتبط
علوم زیستی و بیوفناوری ایمنی شناسی و میکروب شناسی ویروس شناسی
چکیده انگلیسی
Maraviroc is approved for treatment-experienced HIV+ adults in twice-daily administration. Limited data are available on safety, efficacy and use in routine clinical practice, outside of restrictive clinical trials. This retrospective multicenter (27 centers) study included 667 subjects starting a regimen with maraviroc. The primary endpoint was plasma HIV-RNA <50 copies/mL and CD4+ cell count change at 48 and 96 weeks (FDA snapshot analysis). 94.4% had CCR5 tropism (58.3% Trofile™, 29.2% population genotype, and 12% genotyping proviral DNA). Half of the subjects received the drug in scenarios or dosages outside the initial approval. Maraviroc was prescribed for salvage in 346 (51.9%) individuals, as a switch strategy due to toxicity in 135 (38.7%), for immune discordance in 75 (11.2%), and for simplification in 48 (7.2%). After salvage therapy, 223 (64.5%) subjects had HIV-RNA <50 copies/mL at 48 weeks, and 178 (51.4%) at 96 weeks. Darunavir/r was included in 224 (64.7%) subjects and associated with higher rates of virological and immunologic efficacy (p < 0.001). In multivariate analysis MSM (OR 2.25; 95%CI 1.29-3.94) and baseline HIV-RNA <100,000 copies/mL (OR 1.96; 1.06-3.70) were associated with virological suppression. An increase in CD4+ counts was seen at 48 and 96 weeks in subjects with immune discordance (p < 0.001). Maraviroc was used once-daily in 142 (21.3%) subjects overall, and 68 (57.4%) in switch/simplification. No new safety signals were identified. Besides in salvage regimens, maraviroc was frequently used in switch due to toxicity, simplification, and immune discordance. The efficacy in salvage in clinical practice was higher than in phase III clinical trials, likely due to availability of new active drugs in the regimen. These results increase our understanding of the efficacy, safety, and conditions of prescription of maraviroc beyond the initial registrational trials and the early manufacturer pharmacovigilance programs.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Antiviral Research - Volume 120, August 2015, Pages 79-84
نویسندگان
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