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Network meta-analysis of post-exposure prophylaxis randomized clinical trials.
I Fernández1, E de Lazzari1, A Inciarte2
1Infectious Diseases Department-HIV Unit, Hospital Clínic, IDIBAPS, University of Barcelona, Barcelona, Spain.
HIV Medicine
|October 27, 2020
Summary
This network meta-analysis found cobicistat-boosted elvitegravir (EVG/c) to be the most effective post-exposure prophylaxis (PEP) regimen for preventing HIV, showing advantages for integrase inhibitors. EVG/c demonstrated the highest probability for successful PEP completion with minimal adverse events.
Area of Science:
- Infectious Diseases
- Pharmacology
- Public Health
Background:
- Post-exposure prophylaxis (PEP) is crucial for preventing HIV transmission after potential exposure.
- Evaluating the efficacy of different antiretroviral regimens for PEP is essential for optimizing treatment guidelines.
- Network meta-analysis provides a robust method for comparing multiple interventions in clinical trials.
Purpose of the Study:
- To conduct a network meta-analysis of randomized clinical trials to determine the optimal post-exposure prophylaxis (PEP) regimen for HIV prevention.
- To compare the effectiveness of various three-drug PEP regimens based on completion rates and adverse events.
Main Methods:
- A systematic MEDLINE/PubMed search identified randomized clinical trials comparing at least two three-drug PEP regimens with reported completion rates at 28 days.
- Five studies involving 1105 PEP initiations were included, comparing ritonavir-boosted lopinavir (LPV/r) against atazanavir (ATV), cobicistat-boosted elvitegravir (EVG/c), raltegravir (RAL), and maraviroc (MVC).
- Probabilities of each treatment being the best were estimated based on non-completion, discontinuation due to adverse events, switching, lost to follow-up, and overall adverse events.
Main Results:
- Overall, 41% of participants did not complete their PEP course.
- Cobicistat-boosted elvitegravir (EVG/c) showed the highest probability of being the best treatment, associated with lower rates of non-completion, switching, lost to follow-up, and adverse events compared to LPV/r.
- Maraviroc (MVC) was associated with lower rates of PEP discontinuation due to adverse events.
Conclusions:
- Integrase inhibitors, particularly cobicistat-boosted elvitegravir (EVG/c) as a single-tablet regimen, demonstrate significant advantages for post-exposure prophylaxis (PEP).
- The findings support the use of integrase inhibitor-based regimens for improved PEP outcomes and patient adherence.
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