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Meta-Analysis
. 2021 Jul;22(6):423-433.
doi: 10.1111/hiv.13050. Epub 2021 Feb 2.

Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence

Y S Punekar  1 , D Parks  2 , M Joshi  3 , S Kaur  4 , L Evitt  1 , V Chounta  1 , M Radford  1 , D Jha  3 , S Ferrante  2 , S Sharma  4 , J Van Wyk  1 , A de Ruiter  1   5
Affiliations
Meta-Analysis

Effectiveness and safety of dolutegravir two-drug regimens in virologically suppressed people living with HIV: a systematic literature review and meta-analysis of real-world evidence

Y S Punekar et al. HIV Med. 2021 Jul.

Abstract

Objectives: Dolutegravir (DTG) is widely recommended within three-drug regimens. However, similar efficacy and tolerability have also been achieved with DTG within two-drug regimens in clinical trials. This study evaluated the real-world effectiveness and discontinuations in people living with HIV-1 (PLHIV) switching to DTG with lamivudine (3TC) or rilpivirine (RPV).

Methods: This was a one-arm meta-analysis utilizing data from a systematic literature review. Data from real-world evidence studies of DTG + RPV and DTG + 3TC were extracted, pooled and analysed. The primary outcome was the proportion of patients with viral failure (VF; ≥ 50 copies/mL in two consecutive measurements and/or ≥ 1000 copies/mL in a single measurement) at week 48 (W48) and week 96 (W96). Other outcomes included virological suppression (VS; < 50 copies/mL) and discontinuations (W48 and W96). Estimates were calculated for VF, VS as per snapshot (VSS) and on treatment analysis (VSOT), and discontinuations.

Results: Pooled mean estimates of VF for DTG + 3TC and DTG + RPV were 0.8% [95% confidence interval (CI): 0.4-1.3] and 0.6% (95% CI: 0.0-1.6), respectively, at W48. VSS rate at W48 was 85.0% (95% CI: 82.3-87.5) for DTG + 3TC regimen and 92.4% (95% CI: 85.0-97.7) in the DTG + RPV regimen. The DTG + 3TC and DTG + RPV regimens led to discontinuations in 13.6% (95% CI: 11.1-16.2) and 7.2% (95% CI: 2.1-14.4) of patients, respectively, at W48. Similar results were observed at W96.

Conclusions: Treatment with DTG + 3TC or DTG + RPV in clinical practice provides a low rate of VF and a high rate of VS when initiated in virologically suppressed PLHIV with diverse backgrounds.

Keywords: antiretroviral therapy; dolutegravir; lamivudine; meta-analysis; real-world clinical trials; rilpivirine; two-drug regimen.

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Figures

Fig. 1
Fig. 1
PRISMA flow chart showing studies published from 2013 to 2019 investigating the use of dolutegravir (DTG) + lamivudine (3TC) and DTG + rilpivirine (RPV) in people living with HIV‐1 (PLHIV). *One study evaluated both DTG + 3TC and DTG + RPV. ART, antiretroviral therapy; SGA, subgroup available; SLR, systematic literature review.
Fig. 2
Fig. 2
Summary of week 48 meta‐analysis data for dolutegravir (DTG) + lamivudine (3TC) treatment in people living with HIV‐1 (PLHIV): (a) viral failure (VF); (b) viral suppression using snapshot algorithm (VSS); (c) viral suppression on treatment (VSOT); and (d) discontinuations. CI, confidence interval; Wt, weight.
Fig. 3
Fig. 3
Summary of week 48 meta‐analysis data for dolutegravir (DTG) + rilpivirine (RPV) treatment in people living with HIV‐1 (PLHIV): (a) viral failure (VF); (b) viral suppression using snapshot algorithm (VSS); (c) viral suppression on treatment (VSOT); and (d) discontinuations. CI, confidence interval; Wt, weight.
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