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Comparative Study
. 2017 Feb 2;12(2):e0170661.
doi: 10.1371/journal.pone.0170661. eCollection 2017.

Effectiveness and tolerance of single tablet versus once daily multiple tablet regimens as first-line antiretroviral therapy - Results from a large french multicenter cohort study

Laurent Cotte  1   2 , Tristan Ferry  1 , Pascal Pugliese  3 , Marc-Antoine Valantin  4   5   6 , Clotilde Allavena  7 , André Cabié  8   9   10 , Isabelle Poizot-Martin  11   12   13 , David Rey  14 , Claudine Duvivier  15   16 , Antoine Cheret  16   17 , Pierre Dellamonica  3 , Pierre Pradat  2   18 , Jean-Jacques Parienti  19   20 ; Dat’AIDS study group
Affiliations
Comparative Study

Effectiveness and tolerance of single tablet versus once daily multiple tablet regimens as first-line antiretroviral therapy - Results from a large french multicenter cohort study

Laurent Cotte et al. PLoS One. .

Abstract

Objectives: Pill burden during antiretroviral treatment (ART) is associated with worse adherence and impaired virological suppression. We compared the effectiveness, tolerance, and persistence on treatment of single tablet regimens (STRs) with non-STR once-daily regimens in patients receiving first-line ART.

Methods: Retrospective analysis of naïve HIV-1 infected patients prospectively enrolled in the French Dat'AIDS cohort and initiating first-line ART with STRs or once-daily non-STRs from 2004 to 2013. The primary outcome was time to treatment discontinuation defined by any change in the treatment regimen. STR and non-STR groups were compared controlling for baseline risk factors by inverse probability weighted treatment Cox analysis (IPWT) and propensity-score matching (PSM).

Results: Overall, 3212 patients (STR 499, non-STR 2713) were included. Median time to treatment discontinuation was shorter in non-STR patients than in STR patients, both in the IPWT (HR = 0.61, p<0.0001) and the PSM cohort (HR = 0.55, p<0.0001). This difference disappeared when censoring ART modification for simplification, both in the IPWT (HR = 0.97, p = 0.65) and the PSM cohort (HR = 0.91, p = 0.33). A lower rate of virological failure was observed with STRs than with non-STRs in both cohorts (HR = 0.23; p = 0.002 and HR = 0.22, p = 0.003, respectively). A lower rate of treatment modification for adverse event was observed with non-STRs in the IPWT cohort (HR = 1.46, p<0.0001), but not in the PSM cohort (HR = 1.22, p = 0.11).

Conclusion: First-line therapy with STRs was associated with a longer time to treatment discontinuation than with non-STRs. However, when ART modification for simplification was not considered as a failure, STRs and non-STRs were similar.

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Conflict of interest statement

I have read the journal's policy and the authors of this manuscript have the following competing interests: Dr Cotte reports grants from ViiV Healthcare, MSD, non-financial support from Gilead, Janssen, BMS, ViiV Healthcare, MSD, Abbott, outside the submitted work and personal fees from Gilead, Janssen, BMS, ViiV Healthcare, MSD, Abbott. Dr Ferry has nothing to disclose. Dr Pugliese has nothing to disclose. Dr Valantin reports personal fees from ViiV Healthcare, personal fees from Janssen, other conflict of interest from BMS and MSD, outside the submitted work. Dr Allavena reports personal fees from Gilead, BMS, ViiV Healthcare, MSD and Janssen, outside the submitted work. Dr Cabié reports non-financial support from Gilead, Janssen, ViiV Healthcare, MSD, outside the submitted work. Dr Poizot-Martin reports personal fees from Gilead, personal fees from BMS, personal fees from Abbvie, personal fees from ViiV Healthcare, outside the submitted work. Dr Rey reports personal fees from Gilead, non-financial support from Gilead, MSD, and BMS, outside the submitted work. Dr Duvivier reports grants from Gilead, grants from BMS, Janssen, ViiV Healthcare, and MSD, outside the submitted work. Dr Chéret has nothing to disclose. Dr Dellamonica has nothing to disclose. Dr Parienti has nothing to disclose. Pierre Pradat performed medical writing services and received financial support from Dat’AIDS. This does not alter our adherence to PLOS ONE policies on sharing data and materials.

Figures

Fig 1
Fig 1. Overall effectiveness over time.
Only patients remaining on the same therapy at the end of follow-up are considered as treatment success. Failure is defined as treatment discontinuation, occurrence of adverse event, or any cause of treatment modification.
Fig 2
Fig 2. Overall effectiveness over time (simplification censored).
Only patients remaining on the same therapy at the end of follow-up are considered as treatment success. Failure is defined as treatment discontinuation, occurrence of adverse event, or any cause of treatment modification except treatment simplification (censored).
Fig 3
Fig 3. Virological efficacy over time.
Virological failure is defined as viral load (VL) > 1000 copies/mL between W16 and W24 or VL > 200 copies/mL after W24.
Fig 4
Fig 4. Tolerance over time: Failure is defined as the occurrence of an adverse event anytime during therapy.
See this image and copyright information in PMC

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