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Hagino T, Saeki H, Fujimoto E, Kanda N. Long-term effectiveness and safety of upadacitinib for Japanese patients with moderate-to-severe atopic dermatitis: a real-world clinical study. J DERMATOL TREAT 2024; 35:2344591. [PMID: 38653561 DOI: 10.1080/09546634.2024.2344591] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2024] [Accepted: 04/10/2024] [Indexed: 04/25/2024]
Abstract
BACKGROUND Previous clinical trials presented efficacy and safety of Janus kinase 1 inhibitor upadacitinib through 52 weeks for moderate-to-severe atopic dermatitis (AD). OBJECTIVES To assess the effectiveness and safety of upadacitinib through 48 weeks in real-world clinical practice for Japanese AD patients (aged ≥12 years). METHODS This retrospective study included 287 patients with moderate-to severe AD treated with 15 mg (n = 216) or 30 mg (n = 71) of upadacitinib daily. Effectiveness was assessed using eczema area severity index (EASI) scores, atopic dermatitis control tool (ADCT), peak pruritus-numerical rating scale (PP-NRS), and investigator's global assessment (IGA). Safety was evaluated through the incidence of treatment-emergent adverse events. RESULTS From baseline, EASI, ADCT, PP-NRS, and IGA rapidly reduced at week 4, and the reduction was maintained until week 48 of treatment with upadacitinib at both doses. Achievement rates of EASI 75, EASI 90, and EASI 100 at week 48 were 63.5, 30.2, and 7.9 in 15 mg group, and 77.4, 54.8, and 3.2% in 30 mg group, respectively. Acne and herpes zoster were frequent, but no serious adverse events occurred. CONCLUSIONS Upadacitinib was therapeutically effective and tolerable for moderate-to-severe AD through 48 weeks in real-world clinical practice.
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Affiliation(s)
- Teppei Hagino
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | | | - Naoko Kanda
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
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Mpofu R, Kawuma AN, Wasmann RE, Akpomiemie G, Chandiwana N, Sokhela SM, Moorhouse M, Venter WDF, Denti P, Wiesner L, Post FA, Haas DW, Maartens G, Sinxadi P. Determinants of early change in serum creatinine after initiation of dolutegravir-based antiretroviral therapy in South Africa. Br J Clin Pharmacol 2024; 90:1247-1257. [PMID: 38332460 DOI: 10.1111/bcp.16009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 12/20/2023] [Accepted: 01/03/2024] [Indexed: 02/10/2024] Open
Abstract
AIMS Dolutegravir increases serum creatinine by inhibiting its renal tubular secretion and elimination. We investigated determinants of early changes in serum creatinine in a southern African cohort starting first-line dolutegravir-based antiretroviral therapy (ART). METHODS We conducted a secondary analysis of data from participants in a randomized controlled trial of dolutegravir, emtricitabine and tenofovir disoproxil fumarate (TDF) or tenofovir alafenamide fumarate (TAF) (ADVANCE, NCT03122262). We assessed clinical, pharmacokinetic and genetic factors associated with change in serum creatinine from baseline to Week 4 using linear regression models adjusted for age, sex, baseline serum creatinine, HIV-1 RNA concentration, CD4 T-cell count, total body weight and co-trimoxazole use. RESULTS We included 689 participants, of whom 470 had pharmacokinetic data and 315 had genetic data. Mean change in serum creatinine was 11.3 (SD 9.9) μmol.L-1. Factors that were positively associated with change in serum creatinine at Week 4 were increased log dolutegravir area under the 24-h concentration-time curve (change in creatinine coefficient [β] = 2.78 μmol.L-1 [95% confidence interval (CI) 0.54, 5.01]), TDF use (β = 2.30 [0.53, 4.06]), male sex (β = 5.20 [2.92, 7.48]), baseline serum creatinine (β = -0.22 [-0.31, -0.12]) and UGT1A1 rs929596 A→G polymorphism with a dominant model (β = -2.33 [-4.49, -0.17]). The latter did not withstand correction for multiple testing. CONCLUSIONS Multiple clinical and pharmacokinetic factors were associated with early change in serum creatinine in individuals initiating dolutegravir-based ART. UGT1A1 polymorphisms may play a role, but further research on genetic determinants is needed.
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Affiliation(s)
- Rephaim Mpofu
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Aida N Kawuma
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Roeland E Wasmann
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Godspower Akpomiemie
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Nomathemba Chandiwana
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Simiso Mandisa Sokhela
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Michelle Moorhouse
- Ezintsha, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Paolo Denti
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - David W Haas
- Department of Medicine, Vanderbilt University Medical Center, Nashville, Tennessee, USA
- Department of Internal Medicine, Meharry Medical College, Nashville, Tennessee, USA
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Phumla Sinxadi
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
- SAMRC/UCT Platform for Pharmacogenomics Research and Translation (PREMED) unit, Cape Town, South Africa
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Nakatudde I, Katana E, Agnes Odongpiny EL, Nalugga EA, Castelnuovo B, Fowler MG, Musoke P. Prevalence of overweight and obesity among adolescents living with HIV after dolutegravir - based antiretroviral therapy start in Kampala, Uganda. AIDS Res Ther 2024; 21:23. [PMID: 38637785 PMCID: PMC11027216 DOI: 10.1186/s12981-024-00615-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2023] [Accepted: 04/10/2024] [Indexed: 04/20/2024] Open
Abstract
BACKGROUND Dolutegravir (DTG)-based antiretroviral therapy (ART) is currently the preferred first-line treatment for persons living with HIV (PLHIV) including children and adolescents in many low- and middle-income countries including Uganda. However, there are concerns about excessive weight gain associated with DTG especially in adults. There remains paucity of current information on weight-related outcomes among adolescents on DTG. We determined the prevalence of excessive weight gain and associated factors among adolescents living with HIV (ALHIV) receiving DTG-based ART in Kampala, Uganda. METHODS Cross-sectional study involving ALHIV aged 10-19 years on DTG-based ART for at least one year were recruited from public health facilities in Kampala between February and May 2022. Excessive weight gain was defined as becoming overweight or obese per body mass index (BMI) norms while on DTG-based ART for at least one year. Demographic, clinical and laboratory data were collected using interviewer-administered questionnaires and data extracted from medical records. At enrolment, blood pressure and anthropometry were measured and blood was drawn for blood glucose and lipid profile. Data was summarised using descriptive statistics and logistic regression was performed to determine the associated factors. RESULTS We enrolled 165 ALHIV with a median age of 14 years (IQR 12-16). Eighty (48.5%) were female. The median duration on ART and DTG was 8 years (IQR 7-11) and 2 years (IQR 1-3) respectively. At DTG initiation, the majority of participants (152/165, 92.1%) were ART-experienced, and had normal BMI (160/165, 97%). Overall, 12/165 (7.3%) adolescents (95% CI: 4.2-12.4) had excessive weight gain. No factors were significantly associated with excessive weight gain after DTG start in ALHIV. However, all ALHIV with excessive weight gain were females. CONCLUSION Our study found a prevalence of 7.3% of overweight and obesity in ALHIV after initiating DTG. We did not find any factor significantly associated with excessive weight gain in ALHIV on DTG. Nonetheless, we recommend ongoing routine monitoring of anthropometry and metabolic markers in ALHIV as DTG use increases globally, to determine the exact magnitude of excessive weight gain and to identify those at risk of becoming overweight or obese while taking the medication.
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Affiliation(s)
- Irene Nakatudde
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda.
| | - Elizabeth Katana
- College of Health Sciences, Makerere University, Kampala, Uganda
| | - Eva Laker Agnes Odongpiny
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
- School of Medicine, University of St. Andrews, St. Andrews, Scotland
| | - Esther Alice Nalugga
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Barbara Castelnuovo
- Infectious Diseases Institute, College of Health Sciences, Makerere University, Kampala, Uganda
| | - Mary Glenn Fowler
- Department of Pathology, School of Medicine, John Hopkins University, Baltimore, MD, USA
| | - Philippa Musoke
- Makerere University-John Hopkins University Research Collaboration, Kampala, Uganda
- Department of Paediatrics and Child Health, College of Health Sciences, Makerere University, Kampala, Uganda
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Moreno I, Hernández T, Calvo E, Fudio S, Kahatt C, Martínez S, Iglesias JL, Calafati RO, Pérez-Ramos L, Montilla L, Zeaiter A, Lubomirov R. Pharmacokinetics and Safety of Lurbinectedin Administrated with Itraconazole in Cancer Patients: A Drug-Drug Interaction Study. Mar Drugs 2024; 22:178. [PMID: 38667795 PMCID: PMC11050816 DOI: 10.3390/md22040178] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/15/2024] [Revised: 04/11/2024] [Accepted: 04/15/2024] [Indexed: 04/28/2024] Open
Abstract
This open-label, two-part, phase Ib drug-drug interaction study investigated whether the pharmacokinetic (PK) and safety profiles of lurbinectedin (LRB), a marine-derived drug, are affected by co-administration of itraconazole (ITZ), a strong CYP3A4 inhibitor, in adult patients with advanced solid tumors. In Part A, three patients were sequentially assigned to Sequence 1 (LRB 0.8 mg/m2, 1-h intravenous [IV] + ITZ 200 mg/day oral in Cycle 1 [C1] and LRB alone 3.2 mg/m2, 1 h, IV in Cycle 2 [C2]). In Part B, 11 patients were randomized (1:1) to receive either Sequence 1 (LRB at 0.9 mg/m2 + ITZ in C1 and LRB alone in C2) or Sequence 2 (LRB alone in C1 and LRB + ITZ in C2). Eleven patients were evaluable for PK analysis: three in Part A and eight in Part B (four per sequence). The systemic total exposure of LRB increased with ITZ co-administration: 15% for Cmax, area under the curve (AUC) 2.4-fold for AUC0-t and 2.7-fold for AUC0-∞. Co-administration with ITZ produced statistically significant modifications in the unbound plasma LRB PK parameters. The LRB safety profile was consistent with the toxicities described in previous studies. Co-administration with multiple doses of ITZ significantly altered LRB systemic exposure. Hence, to avoid LRB overexposure when co-administered with strong CYP3A4 inhibitors, an LRB dose reduction proportional to CL reduction should be applied.
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Affiliation(s)
- Irene Moreno
- START Madrid—Centro Integral Oncológico Clara Campal (CIOCC), Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
| | - Tatiana Hernández
- START Madrid—FJD, Hospital Universitario Fundación Jiménez Díaz, 28040 Madrid, Spain
| | - Emiliano Calvo
- START Madrid—Centro Integral Oncológico Clara Campal (CIOCC), Hospital Universitario HM Sanchinarro, 28050 Madrid, Spain
| | | | | | | | | | | | | | | | - Ali Zeaiter
- PharmaMar S.A., 28770 Colmenar Viejo, Spain (S.M.)
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Pujari S, Gaikwad S, Panchawagh S, Chitalikar A, Joshi K, Rohekar C, Dabhade D, Bele V. Effectiveness, Weight Changes, and Metabolic Outcomes on Switch to Generic Dolutegravir/Lamivudine Among People with HIV in Western India: An Observational Study. AIDS Res Hum Retroviruses 2024; 40:204-215. [PMID: 38063004 DOI: 10.1089/aid.2022.0167] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2024] Open
Abstract
We assessed the effectiveness and safety of switching to generic dolutegravir/lamivudine (DTG/3TC) among People living with Human Immunodeficiency Virus (PWH) in Western India. In this single-center, retrospective observational study, PWH, who switched to DTG/3TC, were followed for virologic, immunologic, and clinical effectiveness, and safety, including weight changes, hyperglycemia, and dyslipidemia. Multivariate linear mixed-effects models were used to predict average change in weight adjusted for age, sex, duration of previous antiretroviral (ARV) regimens, and baseline weight. From May 2017 to July 2022, out of 434 PWH switched to DTG/3TC, 304 with at least 1 follow-up visit were included. Median [interquartile range (IQR)] age was 54 (IQR 49-61) years and 70.1% were male. Prevalence of baseline comorbidities was 57.9% (hypertension-41.5%, chronic kidney disease-40.9%, and diabetes mellitus-18.8%). Reasons for switch were affordability (47.4%), desire for simplification (41.8%), ARV toxicities (19.1%), and concern about potential toxicities (10.2%). Median (IQR) duration of follow-up on DTG/3TC was 40 (IQR 31-49) weeks. No virologic failure was observed. Rates of virologic suppression [viral load (VL) ≤20 copies/mL or target not detected (TND)] at 12, 24, 48, 72, 96 and 120 weeks were 95.2%, 95.9%, 90%, 100%, 81.3%, and 88.4%, respectively. Only 9 (3%) PWH permanently discontinued DTG/3TC. Predicted adjusted mean weight gain of +3.3 kg was observed at 96 weeks. Switching from tenofovir disoproxil fumarate (TDF)/emtricitabine or lamivudine (XTC)/non-nucleoside reverse transcriptase inhibitor (NNRTI) and duration on DTG/3TC were significantly associated with weight gain. Apart from trend in worsening hyperglycemia (nine PWH with new onset diabetes), no clinically significant change in lipids and estimated glomerular filtration rate (eGFR) was documented. Switching to DTG/3TC is an effective and safe option among virologically suppressed PWH with high comorbidity burden in India. In view of the several advantages of DTG/3TC, it may be considered for potential scale-up in the right population, both in private and public health care settings in India.
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Affiliation(s)
| | | | | | | | - Kedar Joshi
- Institute of Infectious Diseases, Pune, India
| | | | | | - Vivek Bele
- Institute of Infectious Diseases, Pune, India
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Gan L, Xie X, Fu Y, Song Y, Song C, Ren T, Long H. Efficacy and safety of bictegravir/emtricitabine/tenofovir alafenamide fumarate for adult patients with human immunodeficiency virus-1 in China: a retrospective real-world cohort study. Expert Rev Anti Infect Ther 2024; 22:211-217. [PMID: 38058002 DOI: 10.1080/14787210.2023.2292544] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2023] [Accepted: 11/01/2023] [Indexed: 12/08/2023]
Abstract
BACKGROUND This study aimed to evaluate the therapeutic effect and tolerance of bictegravir/emtricitabine/tenofovir alafenamide fumarate (BIC/FTC/TAF) use for 24 weeks in anti-retroviral therapy (ART)-naïve patients in China. METHODS This single-center retrospective cohort study included ART-naïve patients who received BIC/FTC/TAF from July 2021 to April 2022. The proportion of patients with HIV RNA < 50 copies/mL at the end point of 24 weeks (virological suppression rate) was the primary outcome, and the changes in CD4 cell count, CD4/CD8 ratio, weight, blood lipid, and safety were secondary outcomes. RESULTS A total of 80 ART-naïve patients were enrolled. The virological suppression rate was 86.3% at 24 weeks. The median CD4 cell count increased from 212 cells/μL (interquartile range [IQR]: 90.3-398.3) at baseline to 348 cells/μL (IQR: 219.8-541.0) at 24 weeks. The median CD4/CD8 ratio increased from 0.25 (IQR: 0.13-0.37) at baseline to 0.40 (IQR: 0.26-0.66) at 24 weeks. During the follow-up of 80 ART-naïve patients using BIC/FTC/TAF, 16 participants had adverse events; however, these events did not lead to drug withdrawal. CONCLUSION This real-world cohort study showed that BIC/FTC/TAF could achieve good immunological and virological responses in ART-naïve patients. In addition, this study also shows good safety.
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Affiliation(s)
- Lin Gan
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Xiaoxin Xie
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Yanhua Fu
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Yebing Song
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Chunli Song
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Tingting Ren
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
| | - Hai Long
- Infection disease department of Guiyang Public Health Clinical Center, Guiyang Public Health Clinical Center, Guiyang, China
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Esser S, Brunetta J, Inciarte A, Levy I, D'Arminio Monforte A, Lambert JS, van Welzen B, Teruya K, Boffito M, Liu CE, Altuntas Aydın O, Thorpe D, Heinzkill M, Marongiu A, Cassidy T, Haubrich R, D'Amato L, Robineau O. Twelve-month effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide in people with HIV: Real-world insights from BICSTaR cohorts. HIV Med 2024; 25:440-453. [PMID: 38148567 DOI: 10.1111/hiv.13593] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Accepted: 11/17/2023] [Indexed: 12/28/2023]
Abstract
BACKGROUND Real-world evidence is an essential component of evidence-based medicine. The aim of the BICSTaR (BICtegravir Single Tablet Regimen) study is to assess effectiveness and safety of bictegravir/emtricitabine/tenofovir alafenamide (B/F/TAF) in antiretroviral treatment-naïve (TN) and treatment-experienced (TE) people with HIV. METHODS BICSTaR is a prospective, observational cohort study. Participants (≥18 years) are being followed for 24 months. A pooled analysis is presented at 12 months, with the primary endpoint of effectiveness (HIV-1 RNA <50 copies/mL) and secondary endpoints of safety and tolerability (as per protocol). An exploration of patient-reported outcome measures using standardized questionnaires is included. RESULTS Between June 2018 and May 2021, 1552 people with HIV were enrolled across 12 countries. The analysed population comprised 1509 individuals (279 TN, 1230 TE); most were white (76%), male (84%) and had one or more comorbid conditions (68%). Median age was 47 years. After 12 months of B/F/TAF treatment, HIV-1 RNA was <50 copies/mL in 94% (221/236) of TN participants and 97% (977/1008) of TE participants. Median CD4 cell count increased by 214 cells/μL (p < 0.001) in TN participants and 13 cells/μL (p = 0.014) in TE participants; median CD4/CD8 ratios increased by 0.30 and 0.03, respectively (both p < 0.001). Persistence was high at 12 months (TN, 97%; TE, 95%). No resistance to B/F/TAF emerged. Study drug-related adverse events occurred in 13% of participants through 12 months, leading to B/F/TAF discontinuation in 6%. CONCLUSIONS The findings of this study provide robust real-world evidence to support the broad use of B/F/TAF in both TN and TE people with HIV.
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Affiliation(s)
- Stefan Esser
- Clinic of Dermatology, Department of Venerology, University Hospital Essen, Essen, Germany
| | | | - Alexy Inciarte
- HIV Unit, Hospital Clinic of Barcelona, Barcelona, Spain
| | - Itzchak Levy
- Infectious Disease Unit, Sheba Medical Center, Israel and the Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Antonella D'Arminio Monforte
- Clinic of Infectious Diseases, Department of Health Sciences, University of Milan, "ASST Santi Paolo e Carlo", Milan, Italy
| | - John S Lambert
- Mater Misericordiae University Hospital, University College Dublin, Dublin, Ireland
| | - Berend van Welzen
- Department of Infectious Diseases, University Medical Centre Utrecht, Utrecht, Netherlands
| | - Katsuji Teruya
- National Center for Global Health and Medicine: NCGM AIDS Clinical Center (ACC), Tokyo, Japan
| | | | - Chun-Eng Liu
- Department of Internal Medicine, Changhua Christian Hospital, Changhua, Taiwan
| | - Ozlem Altuntas Aydın
- University of Health Sciences, Başakşehir Çam and Sakura City Hospital, Istanbul, Turkey
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Potestio L, Patruno C, Genco L, DI Filippo G, Napolitano M. Kaposi's sarcoma as presentation of HIV in an atopic patient treated with upadacitinib. Ital J Dermatol Venerol 2024; 159:211-212. [PMID: 38650502 DOI: 10.23736/s2784-8671.24.07766-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/25/2024]
Affiliation(s)
- Luca Potestio
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Cataldo Patruno
- Department of Health Sciences, The Magna Græcia University of Catanzaro, Catanzaro, Italy
| | - Lucia Genco
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy -
| | - Giovanni DI Filippo
- Section of Infectious Diseases, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
| | - Maddalena Napolitano
- Section of Dermatology, Department of Clinical Medicine and Surgery, University of Naples Federico II, Naples, Italy
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Hurbans N, Naidoo P. Efficacy, safety, and tolerability of dolutegravir-based ART regimen in Durban, South Africa: a cohort study. BMC Infect Dis 2024; 24:343. [PMID: 38515041 PMCID: PMC10958909 DOI: 10.1186/s12879-024-09202-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/23/2023] [Accepted: 03/06/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND Dolutegravir is an integrase strand transfer inhibitor that has been recommended for use in first-line antiretroviral regimens by the World Health Organisation and is currently being rolled out globally. There has been safety concerns with dolutegravir which has caused concern about its use in the general population. Dolutegravir first-line regimens have been used in South Africa since early 2020. Therefore, the aim of the present study was to assess the efficacy, safety, and tolerability of first-line dolutegravir-based antiretrovirals amongst adults living with HIV in Durban, South Africa. METHODS This was a mixed-methods study, which comprised a cross-sectional survey and longitudinal retrospective follow-up of medical records. The study was conducted between October 2020 and January 2022. Data were described using descriptive and summary statistics. Bivariate logistic regression was applied to socio-demographic and clinical variables and crude odds ratios with a 95% confidence interval was calculated. Pearson chi-square tests, paired sample T-tests, and cross-tabulations were performed on selected variables. RESULTS A total of 461 participants were enrolled in the study. There was a significant change in immunological outcomes (p < 0.001) after dolutegravir initiation. Furthermore, an assessment of laboratory parameters showed that there was a significant decrease in cholesterol (p < 0.001) and increase in creatinine (p < 0.001) levels. Increased weight was shown by 60.7% of the participants but was not associated with age, gender, CD4 counts, and previous antiretroviral usage. The study found that 43.6% of the participants experienced at least one side-effect. A total of 21.6% and 23.2% of the participants experienced neuropsychiatric and central nervous system side-effects, respectively. In the bivariate analyses, only gender was shown to be associated with side-effects, and only 1.7% of the participants discontinued the study due to side-effects. CONCLUSION Our results suggest that dolutegravir is effective, safe, and well tolerated in the study population.
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Affiliation(s)
- Nivriti Hurbans
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Science, University of KwaZulu-Natal, Westville, Durban, 4001, South Africa.
- South African Medical Research Council, HIV and Other Infectious Diseases Research Unit, Durban, South Africa.
| | - Panjasaram Naidoo
- Discipline of Pharmaceutical Sciences, School of Health Sciences, College of Health Science, University of KwaZulu-Natal, Westville, Durban, 4001, South Africa
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Walmsley S, Smith DE, Górgolas M, Cahn PE, Lutz T, Lacombe K, Kumar PN, Wynne B, Grove R, Bontempo G, Moodley R, Okoli C, Kisare M, Jones B, Clark A, Ait-Khaled M. Efficacy and safety of switching to dolutegravir/lamivudine in virologically suppressed people with HIV-1 aged ≥ 50 years: week 48 pooled results from the TANGO and SALSA studies. AIDS Res Ther 2024; 21:17. [PMID: 38515183 PMCID: PMC10958962 DOI: 10.1186/s12981-024-00604-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2023] [Accepted: 03/13/2024] [Indexed: 03/23/2024] Open
Abstract
BACKGROUND As the population of people with HIV ages, concerns over managing age-related comorbidities, polypharmacy, immune recovery, and drug-drug interactions while maintaining viral suppression have arisen. We present pooled TANGO and SALSA efficacy and safety results dichotomized by age (< 50 and ≥ 50 years). METHODS Week 48 data from the open-label phase 3 TANGO and SALSA trials evaluating switch to once-daily dolutegravir/lamivudine (DTG/3TC) fixed-dose combination vs continuing current antiretroviral regimen (CAR) were pooled. Proportions of participants with HIV-1 RNA ≥ 50 and < 50 copies/mL (Snapshot, intention-to-treat exposed) and safety were analyzed by age category. Adjusted mean change from baseline in CD4 + cell count was assessed using mixed-models repeated-measures analysis. RESULTS Of 1234 participants, 80% of whom were male, 29% were aged ≥ 50 years. Among those aged ≥ 50 years, 1/177 (< 1%) DTG/3TC participant and 3/187 (2%) CAR participants had HIV-1 RNA ≥ 50 copies/mL at 48 weeks; proportions with HIV-1 RNA < 50 copies/mL were high in both treatment groups (≥ 92%), consistent with overall efficacy and similar to observations in participants aged < 50 years (≥ 93%). Regardless of age category, CD4 + cell count increased or was maintained from baseline with DTG/3TC. Change from baseline in CD4 + /CD8 + ratio was similar across age groups and between treatment groups. One CAR participant aged < 50 years had confirmed virologic withdrawal, but no resistance was detected. In the DTG/3TC group, incidence of adverse events (AEs) was similar across age groups. Proportions of AEs leading to withdrawal were low and comparable between age groups. Although drug-related AEs were generally low, across age groups, drug-related AEs were more frequent in participants who switched to DTG/3TC compared with those who continued CAR. While few serious AEs were observed in both treatment groups, more were reported in participants aged ≥ 50 years vs < 50 years. CONCLUSIONS Among individuals with HIV-1, switching to DTG/3TC maintained high rates of virologic suppression and demonstrated a favorable safety profile, including in those aged ≥ 50 years despite higher prevalence of concomitant medication use and comorbidities. TRIAL REGISTRATION NUMBER TANGO, NCT03446573 (February 27, 2018); SALSA, NCT04021290 (July 16, 2019).
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Affiliation(s)
- Sharon Walmsley
- University Health Network, 200 Elizabeth Street, Toronto, ON, M5G 2C4, Canada
| | - Don E Smith
- Albion Centre, 150 Albion Street, Surry Hills NSW 2010, Sydney, Australia
| | - Miguel Górgolas
- Fundación Jiménez Díaz, Universidad Autónoma de Madrid, Av. de los Reyes Católicos, 2, 28040, Madrid, Spain
| | - Pedro E Cahn
- Fundación Huésped, Dr. Carlos A. Gianantonio 3932, C1204 CABA, Buenos Aires, Argentina
| | - Thomas Lutz
- Infektiologikum, Stresemannallee 3, 60596, Frankfurt am Main, Frankfurt, Germany
| | - Karine Lacombe
- Hôpital Saint-Antoine, 184 Rue du Faubourg Saint-Antoine, 75012, Paris, France
| | - Princy N Kumar
- Georgetown University Medical Center, 4000 Reservoir Road, NW, Washington, DC, 20057, USA
| | - Brian Wynne
- ViiV Healthcare, 406 Blackwell Street, Suite 300, Durham, NC, 27701, USA
| | - Richard Grove
- GSK, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Gilda Bontempo
- ViiV Healthcare, 36 E Industrial Road, Branford, CT, 06405, USA
| | - Riya Moodley
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Chinyere Okoli
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Michelle Kisare
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK.
| | - Bryn Jones
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Andrew Clark
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
| | - Mounir Ait-Khaled
- ViiV Healthcare, 980 Great West Road, Brentford, Middlesex, TW8 9GS, UK
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Abstract
OBJECTIVES In 2018, the Botswana Tsepamo Study reported a nine-fold increased risk of neural tube defects in infants whose mothers were treated with dolutegravir (DTG) from the time of conception. As maternal folate supplementation and status is a well known modifier of neural tube defect (NTD) risk, we sought to evaluate birth outcomes in mice fed normal and low folic acid diets treated with DTG during pregnancy. DESIGN DTG was evaluated for developmental toxicity using pregnant mice fed normal or low folic acid diet. METHODS CD-1 mice were provided diet with normal (3 mg/kg) or low (0.3 mg/kg) folic acid. They were treated with water, a human therapeutic-equivalent dose, or supratherapeutic dose of DTG from mouse embryonic day E6.5 to E12.5. Pregnant dams were sacrificed at term (E18.5) and fetuses were inspected for gross, internal, and skeletal defects. RESULTS Fetuses with exencephaly, an NTD, were present in both therapeutic human equivalent and supratherapeutic exposures in dams fed low folic acid diet. Cleft palates were also found under both folate conditions. CONCLUSIONS Recommended dietary folic acid levels during mouse pregnancy ameliorate developmental defects that arise from DTG exposure. Since low folate status in mice exposed to DTG increases the risk for NTDs, it is possible that DTG exposures in people living with HIV with low folate status during pregnancy may explain, at least in part, the elevated NTD risk signal observed in Botswana. Based on these results, future studies should consider folate status as a modifier for DTG-associated NTD risk.
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Affiliation(s)
- Gabriel L. TUKEMAN
- Baylor College of Medicine, Department of Molecular and Cellular Biology, Houston, TX
| | - Hui WEI
- Baylor College of Medicine, Department of Molecular and Cellular Biology, Houston, TX
| | - Richard H. FINNELL
- Baylor College of Medicine, Department of Molecular and Cellular Biology, Houston, TX
- Baylor College of Medicine, Department of Molecular and Human Genetics, Houston, TX
- Baylor College of Medicine, Department of Medicine, Houston, TX
| | - Robert M. CABRERA
- Baylor College of Medicine, Department of Molecular and Cellular Biology, Houston, TX
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Moyle G, Assoumou L, de Castro N, Post FA, Curran A, Rusconi S, De Wit S, Stephan C, Raffi F, Johnson M, Masia M, Vera J, Jones B, Grove R, Fletcher C, Duffy A, Morris K, Pozniak A. Switching to dolutegravir plus rilpivirine versus maintaining current antiretroviral therapy regimen in virologically suppressed people with HIV-1 and the Lys103Asn (K103N) mutation: 48-week results from a randomised, open-label pilot clinical trial. Lancet HIV 2024; 11:e156-e166. [PMID: 38417976 DOI: 10.1016/s2352-3018(23)00292-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2023] [Revised: 10/26/2023] [Accepted: 10/30/2023] [Indexed: 03/01/2024]
Abstract
BACKGROUND The combination of dolutegravir plus rilpivirine has been studied in people with virologically suppressed HIV with no previous history of treatment failure or resistance. We investigated the potential to maintain viral suppression with dolutegravir plus rilpivirine in people with Lys103Asn mutations whose HIV was previously managed with other treatment regimens. METHODS In this open-label pilot trial at 32 clinical sites in seven European countries, virologically suppressed, HBsAg-negative adults aged 18 years or older with HIV-1 and Lys103Asn mutations were randomly assigned (2:1) to switch to 50 mg dolutegravir plus 25 mg rilpivirine (given as a single tablet) once daily or to continue their current antiretroviral therapy regimen (control group). After 48 weeks, participants in the control group also switched to dolutegravir plus rilpivirine. Randomisation was stratified by country, and a computer-generated randomisation list with permuted blocks within strata was used to assign participants to treatment groups. The primary endpoints were virological failure (ie, two consecutive measurements of 50 copies or more of HIV RNA per mL at least 2 weeks apart) and virological suppression (the proportion of participants with fewer than 50 copies of HIV RNA per mL) at week 48 (week 96 data will be reported separately). Analyses were done in the modified intention-to-treat population, which included all participants who received at least one dose of the study medication. This trial is registered with ClinicalTrials.gov, NCT05349838, and EudraCT, 2017-004040-38. FINDINGS Between Nov 5, 2018, and Dec 9, 2020, 140 participants were enrolled and randomly assigned, 95 to the dolutegravir plus rilpivirine group and 45 to the control group. Virological failure was recorded in three participants (3·2%, 95% CI 0·7 to 9·0) in the the dolutegravir plus rilpivirine group and one (2·2%, 0·1 to 11·8) in the control group. The proportion of participants in whom virological suppression was maintained at week 48 was 88·4% (80·2 to 94·1) in the dolutegravir plus rilpivirine group versus 88·9% (75·9 to 96·3) in the control group (difference -0·5, -11·7 to 10·7). Significantly more adverse events were recorded in the dolutegravir plus rilpivirine group than in the control group (234 vs 72; p=0·0034), but the proportion of participants who reported at least one adverse event was similar between groups (76 [80%] of 95 vs 33 [73%] of 45; p=0·39). The frequency of serious adverse events was low and similar between groups. INTERPRETATION Virological suppression was maintained at week 48 in most participants with Lys103Asn mutations when they switched from standard regimens to dolutegravir plus rilpivirine. The results of this pilot study, if maintained when the week 96 data are reported, support conduct of a large, well-powered trial of dolutegravir plus rilpivirine. FUNDING ViiV Healthcare.
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Affiliation(s)
| | - Lambert Assoumou
- Institut Pierre Louis d'Epidémiologie et de Santé Publique, INSERM, Sorbonne Université, Paris, France
| | | | - Frank A Post
- King's College Hospital NHS Foundation Trust, London, UK
| | - Adrian Curran
- Hospital Universitari Vall d'Hebron, Vall d'Hebron Research Institute, Barcelona, Spain
| | - Stefano Rusconi
- Dipartimento di Scienze Biomediche e Cliniche Luigi Sacco, University of Milan, Milan, Italy; Infectious Disease Unit, Aziende Socio Sanitarie Territoriali Ovest Milanese, Legnano, Italy
| | | | - Christoph Stephan
- University Hospital Frankfurt, Goethe-University, Frankfurt, Germany
| | - François Raffi
- Centre Hospitalier Universitaire de Nantes, Nantes, France; Centre d'Investigation Clinique 1413, INSERM, Nantes, France
| | | | - Mar Masia
- General University Hospital of Elche, Elche, Spain; Centro de investigación Biomédica en Red de Enfermedades Infecciosas, Instituto de Salud Carlos III, Madrid, Spain
| | - Jaime Vera
- Brighton and Sussex University Hospitals, Brighton, UK; Brighton and Sussex Medical School Centre for Global Health Research, Brighton, UK
| | | | | | | | | | | | - Anton Pozniak
- Chelsea and Westminster Hospital, London, UK; London School of Hygiene & Tropical Medicine, London, UK
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13
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Sequera-Arquelladas S, Hidalgo-Tenorio C, López-Cortés L, Gutiérrez A, Santos J, Téllez F, Omar M, Ferra-Murcia S, Fernández E, Javier R, García-Vallecillos C, Pasquau J. DOLAMA 200: Effectiveness and Safety of a Dual Therapy with Dolutegravir Plus Lamivudine in Treatment-Experienced HIV-1 Infected Real World Participants in Spain. Viruses 2024; 16:259. [PMID: 38400035 PMCID: PMC10893067 DOI: 10.3390/v16020259] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2023] [Revised: 01/14/2024] [Accepted: 02/01/2024] [Indexed: 02/25/2024] Open
Abstract
The continuous pharmacological advances in antiretroviral treatment (ART) and the increasing understanding of HIV drug resistance has led to a change in the paradigm of ART optimization in the setting of the viral suppression of treatment-experienced patients with the emerging evidence of the effectiveness and safety of dual therapies. The aim of this study is to determine the antiviral efficacy and safety of switching to Dolutegravir + Lamivudine in people living with HIV, and to analyze the rate of patients with virologic failure (VF). A total of 200 patients were included with a median age of 51 years, 189 cells/µL of nadir CD4+, 13 years on ART and four previous ART regimens. Among the 168 patients who completed a follow-up at 48 weeks, a total of five VFs occurred, resulting in a 2.98% (5/168) VF rate. The results of the intention-to-treat analysis were a VF rate of 2.54% (5/197), and the rate of patients/year with viral suppression was 98.3% (298/303) in the observed data analysis. We observed a significant improvement in mean CD4 lymphocytes, the CD4/CD8 ratio and lipid profiles. The optimization of ART to DTG plus 3TC is a cost-effective switch option for treatment-experienced HIV patients, and also improves their lipid profiles.
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Affiliation(s)
- Sergio Sequera-Arquelladas
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Carmen Hidalgo-Tenorio
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Luis López-Cortés
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Alicia Gutiérrez
- Department of Infectious Diseases, Virgen del Rocio University Hospitals, 41013 Seville, Spain; (L.L.-C.); (A.G.)
| | - Jesús Santos
- IBIMA Plataforma BIONAND, Unit of Infectious Diseases, Virgen de la Victoria University Hospital, 29010 Málaga, Spain;
| | - Francisco Téllez
- Unit of Infectious Diseases, Puerto Real Universitary Hospital, 11510 Cádiz, Spain;
| | - Mohamed Omar
- Unit of Infectious Diseases, Hospital Complex of Jaen, 23007 Jaén, Spain;
| | - Sergio Ferra-Murcia
- Unit of Infectious Diseases, Hospital Torrecárdenas Hospital, 04009 Almería, Spain;
| | - Elisa Fernández
- Internal medicine Service, Hospital Poniente, 04700 Almería, Spain;
| | - Rosario Javier
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Coral García-Vallecillos
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
| | - Juan Pasquau
- Unit of Infectious Diseases, Instituto de Investigación Biosanitario de Granada (IBS-Granada), Virgen de las Nieves University Hospital, 18014 Granada, Spain; (C.H.-T.); (R.J.); (C.G.-V.); (J.P.)
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14
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Schlösser AR, Boeijink N, Olydam J, Nijsten TEC, Hijnen D. Upadacitinib treatment in a real-world difficult-to-treat atopic dermatitis patient cohort. J Eur Acad Dermatol Venereol 2024; 38:384-392. [PMID: 37864486 DOI: 10.1111/jdv.19581] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2023] [Accepted: 09/29/2023] [Indexed: 10/23/2023]
Abstract
BACKGROUND Upadacitinib was the first JAK-1 selective inhibitor registered for the treatment of moderate-to-severe atopic dermatitis (AD). Although efficacy and safety have been shown in clinical trials, real-world data on the use of upadacitinib in patients that have been treated with other immunosuppressants and targeted therapies is limited. OBJECTIVES To provide real-world evidence on the use of upadacitinib treatment in moderate-to-severe atopic dermatitis. METHODS In this prospective observational single-centre study, all AD patients treated with upadacitinib treatment in the context of standard care were included between August 2021 and September 2022. Clinical outcome measures and adverse events (AEs) were analysed. RESULTS Forty-eight patients were included. The majority (n = 39; 81%) had failed (ineffectiveness) on other targeted therapies, including other JAK inhibitors and biologics. Thirty-four (71%) patients were still using upadacitinib treatment at last follow up (median duration 46.5 weeks). Fourteen (29%) patients discontinued treatment due to ineffectiveness or AE. Upadacitinib treatment led to a significant decrease of disease severity during a median follow up of 37.5 weeks. Median IGA at baseline decreased from 3 (IQR 2-3) to 1.5 (IQR 1-2) at last review (p < 0.001). Median NRS itch decreased from 7 (IQR 5-8) at baseline to 2.25 (IQR 0.25-6.5) at last review (p < 0.001). Three patients discontinued treatment due to AE. Forty-eight AEs were reported, including acne-like eruptions (25%), nausea (13%) and respiratory tract infections (10%). CONCLUSIONS In this real-world cohort, we confirmed that upadacitinib is an effective treatment in a subset of AD patients that have failed several previous systemic immunosuppressive and biologic treatments. Overall, AE were mostly well tolerated and not a reason to discontinue treatment for most patients.
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Affiliation(s)
- Anne R Schlösser
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Neill Boeijink
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Jill Olydam
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - Tamar E C Nijsten
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
| | - DirkJan Hijnen
- Department of Dermatology, Erasmus MC University Medical Center, Rotterdam, the Netherlands
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15
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Shamu T, Egger M, Mudzviti T, Chimbetete C, Manasa J, Anderegg N. Body weight and blood pressure changes on dolutegravir-, efavirenz- or atazanavir-based antiretroviral therapy in Zimbabwe: a longitudinal study. J Int AIDS Soc 2024; 27:e26216. [PMID: 38332525 PMCID: PMC10853595 DOI: 10.1002/jia2.26216] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/30/2023] [Accepted: 01/23/2024] [Indexed: 02/10/2024] Open
Abstract
INTRODUCTION Dolutegravir (DTG) is widely used for antiretroviral therapy (ART). We compared weight and blood pressure trends and examined the association between high blood pressure and weight gain among people living with HIV (PLHIV) switching to or starting DTG-based, efavirenz (EFV)-based and ritonavir-boosted atazanavir (ATV/r)-based ART in Zimbabwe. METHODS PLHIV aged 18 years or older who started or switched to DTG, EFV or ATV/r-based ART between January 2004 and June 2022 at Newlands Clinic in Harare, Zimbabwe, were eligible. Weight was measured at all visits (Seca floor scales); blood pressure only at clinician-led visits (Omron M2 sphygmomanometer). We used Bayesian additive models to estimate trends in weight gain and the proportion with high blood pressure (systolic >140 mmHg or diastolic >90 mmHg) in the first 2 years after starting or switching the regimen. Finally, we examined whether trends in the proportion with high blood pressure were related to weight change. RESULTS We analysed 99,969 weight and 35,449 blood pressure records from 9487 adults (DTG: 4593; EFV: 3599; ATV/r: 1295). At 24 months after starting or switching to DTG, estimated median weight gains were 4.54 kg (90% credibility interval 3.88-5.28 kg) in women and 3.71 kg (3.07-4.45 kg) in men, around twice that observed for ATV/r and over four-times the gain observed for EFV. Prevalence of high blood pressure among PLHIV receiving DTG-based ART increased from around 5% at baseline to over 20% at 24 months, with no change in PLHIV receiving EFV- or ATV/r-based ART. High blood pressure in PLHIV switching to DTG was associated with weight gain, with stronger increases in the proportion with high blood pressure for larger weight gains. CONCLUSIONS Among PLHIV starting ART or switching to a new regimen, DTG-based ART was associated with larger weight gains and a substantial increase in the prevalence of high blood pressure. Routine weight and blood pressure measurement and interventions to lower blood pressure could benefit PLHIV on DTG-based ART. Further studies are needed to elucidate the mechanisms and reversibility of these changes after discontinuation of DTG.
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Affiliation(s)
- Tinei Shamu
- Newlands ClinicHarareZimbabwe
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Graduate School of Health SciencesUniversity of BernBernSwitzerland
| | - Matthias Egger
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
- Population Health Sciences, Bristol Medical SchoolUniversity of BristolBristolUK
| | - Tinashe Mudzviti
- Newlands ClinicHarareZimbabwe
- Department of Pharmacy and Pharmaceutical SciencesUniversity of ZimbabweHarareZimbabwe
| | | | | | - Nanina Anderegg
- Institute of Social and Preventive MedicineUniversity of BernBernSwitzerland
- Centre for Infectious Disease Epidemiology and ResearchSchool of Public HealthUniversity of Cape TownCape TownSouth Africa
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Calza L, Colangeli V, Legnani G, Cretella S, Bon I, Viale P. Efficacy and Safety of Switching to Dolutegravir/Lamivudine in Virologically Suppressed People Living with HIV-1 Aged Over 65 Years. AIDS Res Hum Retroviruses 2024; 40:73-79. [PMID: 37335031 DOI: 10.1089/aid.2023.0046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/21/2023] Open
Abstract
Clinical trials of dual regimen dolutegravir/lamivudine (DOL/3TC) demonstrated potent efficacy and favorable safety in both antiretroviral therapy-naïve and -experienced patients, but data on older people are lacking. We aimed to evaluate virological efficacy and safety of DOL/3TC in suppressed older patients over a 12-month period. We performed a retrospective cohort study evaluating people living with HIV (PLWHIV) aged ≥65 years at our HIV Clinic who were switched to DOL/3TC. Eligible patients had baseline HIV-1 RNA <20 copies/mL, and no previous virological failures or known resistance mutations for lamivudine or dolutegravir. Inclusion criteria were met by 72 patients: 59 were men, median age was 69.2 years, and one or more comorbidities were present in 89% of patients. The most common reason for switch was simplification, followed by drug-drug interactions (DDIs) and toxicities. After 12 months, 64 (88.9%, by the intention-to-treat analysis) patients maintained HIV-1 RNA <20 copies/mL, and reasons for treatment failure were virological failure in three cases, adverse events in three, and missing data in two. Genotype resistance testing showed no resistance mutations for lamivudine or dolutegravir in subjects with virological failure. The number of potential DDIs decreased from 92 to 12 after switching to DOL/3TC, and a significant reduction in median total and low-density lipoprotein cholesterol was reported, while median change in body weight was not significant. In this real-life cohort, switching to DOL/3TC was associated with maintenance of virological control and good tolerability among persons aged >65 years, supporting use of this dual regimen in older PLWHIV.
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Affiliation(s)
- Leonardo Calza
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Vincenzo Colangeli
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Giorgio Legnani
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Silvia Cretella
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Isabella Bon
- Unit of Microbiology, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
| | - Pierluigi Viale
- Unit of Infectious Diseases, Department of Medical and Surgical Sciences, S.Orsola Hospital, IRCCS Azienda Ospedaliero-Universitaria di Bologna, Bologna, Italy
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Sagami S, Kobayashi T. Editorial: Extending upadacitinib induction dosing in ulcerative colitis-A delicate balance of efficacy and safety. Aliment Pharmacol Ther 2024; 59:579-580. [PMID: 38247151 DOI: 10.1111/apt.17829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
LINKED CONTENTThis article is linked to Panaccione et al papers. To view these articles, visit https://doi.org/10.1111/apt.17816 and https://doi.org/10.1111/apt.17853
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Affiliation(s)
- Shintaro Sagami
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
| | - Taku Kobayashi
- Center for Advanced IBD Research and Treatment, Kitasato University Kitasato Institute Hospital, Tokyo, Japan
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Panaccione R, Danese S, Zhou W, Klaff J, Ilo D, Yao X, Levy G, Higgins PDR, Loftus EV, Chen S, Gonzalez YS, Leonard C, Hébuterne X, Lindsay JO, Cao Q, Nakase H, Colombel JF, Vermeire S. Efficacy and safety of upadacitinib for 16-week extended induction and 52-week maintenance therapy in patients with moderately to severely active ulcerative colitis. Aliment Pharmacol Ther 2024; 59:393-408. [PMID: 38010661 DOI: 10.1111/apt.17816] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2023] [Revised: 06/21/2023] [Accepted: 11/07/2023] [Indexed: 11/29/2023]
Abstract
BACKGROUND Upadacitinib is an oral, selective Janus kinase inhibitor. AIM To assess the efficacy and safety of upadacitinib in patients with moderate-to-severe ulcerative colitis following 16-week extended induction therapy, and 52-week maintenance therapy in patients achieving clinical response after 16-week extended induction therapy METHODS: Patients without clinical response to 8 weeks' upadacitinib 45 mg once daily induction therapy in two induction trials were eligible for an additional 8 weeks of therapy. Patients achieving clinical response at Week 16 were subsequently re-randomised (1:1) to upadacitinib 15 or 30 mg once daily for 52-week maintenance therapy. Efficacy was assessed at induction Week 16 (integrated) and maintenance Week 52; safety was assessed throughout. RESULTS Overall, 127/663 (19.2%) patients did not achieve clinical response to upadacitinib 45 mg at Week 8 and received an additional 8 weeks of therapy; 75/127 (59.1%) subsequently achieved clinical response at Week 16 and entered the maintenance trial. At Week 52, 26.5% of patients receiving upadacitinib 15 mg, and 43.6% receiving 30 mg, achieved clinical remission; efficacy was observed across all other endpoints with both doses. Herpes zoster rates increased with longer duration (16 weeks) of exposure to upadacitinib 45 mg during induction compared with the same population during the first 8 weeks. No other new safety signals were observed, and results are otherwise consistent with the known safety profile of upadacitinib. CONCLUSIONS Patients without clinical response after 8 weeks' upadacitinib 45 mg induction therapy, may benefit from an additional 8 weeks of therapy. CLINICAL TRIAL REGISTRATION NCT02819635; NCT03653026.
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Affiliation(s)
- Remo Panaccione
- Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
| | - Silvio Danese
- Gastroenterology and Endoscopy, IRCCS Ospedale San Raffaele, University Vita-Salute San Raffaele, Milan, Italy
| | - Wen Zhou
- AbbVie Inc, North Chicago, Illinois, USA
| | | | - Dapo Ilo
- AbbVie Inc, North Chicago, Illinois, USA
| | - Xuan Yao
- AbbVie Inc, North Chicago, Illinois, USA
| | | | - Peter D R Higgins
- Department of Internal Medicine, Division of Gastroenterology, University of Michigan, Ann Arbor, Michigan, USA
| | - Edward V Loftus
- Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, Minnesota, USA
| | - Su Chen
- AbbVie Inc, North Chicago, Illinois, USA
| | | | | | - Xavier Hébuterne
- Department of Gastroenterology and Clinical Nutrition, CHU de Nice, Université Côte d'Azur, Nice, France
| | - James O Lindsay
- Department of Gastroenterology, The Royal London Hospital, Barts Health NHS Trust, London, UK
| | - Qian Cao
- Department of Gastroenterology, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, Hangzhou, China
| | - Hiroshi Nakase
- Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan
| | | | - Séverine Vermeire
- Department of Gastroenterology and Hepatology, University Hospital Leuven, Leuven, Belgium
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Panaccione R. Editorial: Extending upadacitinib induction dosing in ulcerative colitis-A delicate balance of efficacy and safety. Author's reply. Aliment Pharmacol Ther 2024; 59:581-582. [PMID: 38247143 DOI: 10.1111/apt.17853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
LINKED CONTENTThis article is linked to Panaccione et al papers. To view these articles, visit https://doi.org/10.1111/apt.17816 and https://doi.org/10.1111/apt.17829
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Affiliation(s)
- Remo Panaccione
- Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, Alberta, Canada
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20
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Lemaitre F, Lagoutte-Renosi J, Gagnieu MC, Parant F, Venisse N, Grégoire M, Bouchet S, Garraffo R, Lê MP, Muret P, Comets E, Solas C, Peytavin G. Therapeutic drug monitoring and virological response at week 48 in a cohort of HIV-1-infected patients switching to dolutegravir/rilpivirine dual maintenance therapy (ANRS-MIE-BIRIDER study). Br J Clin Pharmacol 2024; 90:264-273. [PMID: 37602480 DOI: 10.1111/bcp.15890] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 07/07/2023] [Accepted: 08/06/2023] [Indexed: 08/22/2023] Open
Abstract
AIMS Dolutegravir (DTG) and rilpivirine (RPV) dual therapy is now recommended as a switch option in virologically suppressed HIV patients. Literature suggests that virological failure with dual therapy could possibly relate to subtherapeutic drug concentrations. In this study, we aimed at describing the DTG and RPV trough plasma concentrations (Cmin) and plasma HIV-1 RNA viral load (VL) during maintenance dual therapy. METHODS We performed a retrospective analysis of DTG and RPV therapeutic drug monitoring in people living with HIV/AIDS (PLWHA) with dual therapy in 9 French centres. DTG and RPV trough plasma concentrations were estimated using a Bayesian approach to predict Cmin. The relationship between the pharmacokinetics of DTG and RPV and VL > 50 copies (cp)/mL was explored using joint nonlinear mixed models. The frequency of subtherapeutic threshold (DTG Cmin below 640 ng/mL and RPV Cmin below 50 ng/mL) were compared between PLWHA presenting VL > 50 cp/mL or not during the study. RESULTS At baseline, 209 PLWHA were enrolled in the study. At week 48, 19 people living with HIV/AIDS (9.1%) discontinued their treatment and 15 PLWHA (7.1%) exhibited VL > 50 cp/mL. Six PLWHA out of 15 (40.0%) with VL > 50 cp/mL during the follow-up had at least 1 Cmin below the respective thresholds while only 26/194 patients (13.4%) without virological replication had at least 1 concentration below the threshold (P = .015). CONCLUSION A majority of PLWHA receiving DTG/RPV maintenance dual therapy demonstrated VL < 50 cp/mL but virological replication was more frequent in people living with HIV/AIDS with subtherapeutic Cmin.
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Affiliation(s)
- Florian Lemaitre
- Univ Rennes, CHU Rennes, Inserm, EHESP, Irset (Institut de recherche en santé, environnement et travail)-UMR_S 1085, Rennes, France
| | - Jennifer Lagoutte-Renosi
- MPFRPV, Université de Franche-Comté, Besançon, France
- Service de Pharmacologie Clinique et Toxicologie, CHU Besançon, Besançon, France
| | - Marie-Claude Gagnieu
- Hospices Civils de Lyon - Groupement Hospitalier Sud - Service de Biochimie et Biologie Moléculaire - UM Pharmacologie-Toxicologie, Pierre-Benite, France
| | - François Parant
- Hospices Civils de Lyon - Groupement Hospitalier Sud - Service de Biochimie et Biologie Moléculaire - UM Pharmacologie-Toxicologie, Pierre-Benite, France
| | - Nicolas Venisse
- Laboratoire de Toxicologie et Pharmacocinétique, CHU Poitiers, Poitiers, France
- CIC Inserm 1402, Poitiers, France
- EBI, UMR CNRS 7267, Poitiers, France
| | - Matthieu Grégoire
- Cibles et médicaments des infections et de l'immunité, Nantes Université, CHU Nantes, Nantes, France
- Service de Pharmacologie Clinique, Nantes Université, CHU Nantes, Nantes, France
| | - Stéphane Bouchet
- Laboratoire de Pharmacologie et Toxicologie, Service de Pharmacologie Médicale, CHU Pellegrin, INSERM U1219, Bordeaux, France
| | - Rodolphe Garraffo
- Service de Pharmacologie et Toxicologie Médicales et CHU de Nice, Nice, France
| | - Minh P Lê
- AP-HP Nord, Pharmacology Department, Bichat Claude-Bernard University Hospital, Paris, France
- INSERM - S 1144, Université Paris Cité, Paris, France
| | - Patrice Muret
- MPFRPV, Université de Franche-Comté, Besançon, France
- Service de Pharmacologie Clinique et Toxicologie, CHU Besançon, Besançon, France
| | - Emmanuelle Comets
- INSERM, CIC 1414, Rennes, France
- Univ Rennes-1, Rennes, France
- INSERM, IAME, Université de Paris, Paris, France
| | - Caroline Solas
- APHM, Hôpital La Timone, Laboratoire de Pharmacocinétique et Toxicologie, Unité des Virus Émergents (UVE: Aix-Marseille Univ-IRD 190-Inserm 1207), Marseille, France
| | - Gilles Peytavin
- AP-HP Nord, Pharmacology Department, Bichat Claude-Bernard University Hospital, Paris, France
- INSERM - UMR 1137, IAME, Université Paris Cité, Paris, France
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Zhang H, Hindman JT, Lin L, Davis M, Shang J, Xiao D, Avihingsanon A, Arora P, Palaparthy R, Girish S, Marathe DD. A study of the pharmacokinetics, safety, and efficacy of bictegravir/emtricitabine/tenofovir alafenamide in virologically suppressed pregnant women with HIV. AIDS 2024; 38:F1-F9. [PMID: 37939141 PMCID: PMC10715703 DOI: 10.1097/qad.0000000000003783] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2023] [Accepted: 10/31/2023] [Indexed: 11/10/2023]
Abstract
OBJECTIVE The objective of this study was to assess the pharmacokinetics, safety, and efficacy and confirm the dose of once-daily bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF; B/F/TAF) during pregnancy. DESIGN An open-label, multicenter, single-arm, phase 1b study (NCT03960645) was conducted in 33 virologically suppressed pregnant women with HIV-1. METHODS Participants received B/F/TAF (50/200/25 mg) from the second or third trimester through ∼16 weeks postpartum. Steady-state maternal plasma pharmacokinetic samples were collected at the second and third trimesters and 6 and 12 weeks postpartum for BIC, FTC, and TAF. Neonates ( n = 29) were followed from birth to 4-8 weeks with sparse washout pharmacokinetic sampling for BIC and TAF. The proportion of participants with HIV-1 RNA less than 50 copies/ml at delivery (missing = excluded) was evaluated. RESULTS Mean areas under the concentration-time curve over the dosing interval (AUC tau ) for BIC, FTC, and TAF were lower during pregnancy versus postpartum but were closer to AUC tau values for nonpregnant adults with HIV reported in other studies. Geometric least-squares mean ratios for BIC, FTC, and TAF AUC tau during pregnancy versus postpartum ranged from 41 to 45%, 64 to 69% and 57 to 78%, respectively. Mean BIC trough concentrations during pregnancy were more than 6.5-fold greater than the protein-adjusted 95% effective concentration. In neonates, the median BIC half-life was 43 h. Virologic suppression was maintained in all adult participants throughout the study, with no virologic failure or treatment-emergent resistance to HIV-1, no discontinuations because of adverse events, and no perinatal transmission. CONCLUSION Exposures to BIC, FTC, and TAF were lower during pregnancy than postpartum. However, mean BIC trough concentrations were maintained at levels indicative of efficacious exposure, and FTC/TAF data were concordant with published literature in this population. Pharmacokinetic and safety data, combined with maintenance of robust virologic suppression, suggest that once-daily B/F/TAF without dose adjustment is appropriate during pregnancy.
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Affiliation(s)
| | | | - Ludwig Lin
- Gilead Sciences, Inc., Foster City, CA, USA
| | | | | | | | - Anchalee Avihingsanon
- HIV-NAT Thai Red Cross AIDS Research Centre and Center of Excellence in Tuberculosis, Faculty of Medicine, Chulalongkorn University, Bangkok, Thailand
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22
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Hill A, Venter WDF. Clinical consequences of weight gain during treatment for HIV infection. Curr Opin HIV AIDS 2024; 19:21-29. [PMID: 37934677 DOI: 10.1097/coh.0000000000000829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2023]
Abstract
PURPOSE OF REVIEW The introduction of dolutegravir, an oral integrase inhibitor, within public health HIV programs has been a success, with excellent sustained viral load suppression, persistence, and safety. Initial concerns around integrase-inhibitors being implicated in safety concerns around immune reconstitution inflammatory syndromes (IRIS), neural tube defects, and weight gain, have been largely laid to rest, but new concerns about cardiovascular risk have arisen, including a link between hypertension and this antiretroviral class. RECENT FINDINGS We review the pertinent studies here, and while we find both observational and randomized controlled study associations in some but not all studies, these are often confounded by associated weight gain and aging. In addition, definitions of hypertension, as well as measurement within the studies (such as cuff size), were not consistent within studies. SUMMARY Careful analysis will be needed, as with the weight-gain signal, before assigning causation, especially as plausible physiological mechanisms for this rise in blood pressure are unclear.
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Affiliation(s)
- Andrew Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
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Jemal M, Shibabaw Molla T, Tiruneh G. Medhin M, Chekol Abebe E, Asmamaw Dejenie T. Blood glucose level and serum lipid profiles among people living with HIV on dolutegravir-based versus efavirenz-based cART; a comparative cross-sectional study. Ann Med 2023; 55:2295435. [PMID: 38118463 PMCID: PMC10763893 DOI: 10.1080/07853890.2023.2295435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Accepted: 12/11/2023] [Indexed: 12/22/2023] Open
Abstract
BACKGROUND Antiretroviral therapy-linked metabolic abnormalities have become a growing concern among people living with HIV. There is limited data regarding the effects of dolutegravir-based treatment on blood glucose levels and serum lipid profiles in people living with HIV in Ethiopia. Thus, this study aimed to assess blood glucose levels and serum lipid profiles among people living with HIV on dolutegravir-based versus efavirenz-based therapy. METHOD AND MATERIALS An institutional-based comparative cross-sectional study was conducted from 30 June 2021 to 30 August 2021. A total of 128 participants (64 in the dolutegravir-based group and 64 in the efavirenz-based group) were enrolled in the study. The Chi-square, independent t-test, Mann-Whitney U-test, and logistic regression were used as appropriate statistical tests using SPSS Version 26.0 for this study. A p-value of <0.05 was considered statistically significant. RESULT The prevalence of hyperglycemia and dyslipidemia were 17.2% (11/64) and 79.7% (51/64) in the dolutegravir group, and 9.4% (6/64) and 75% (48/64) in the efavirenz group, respectively. The efavirenz group had significantly higher mean values of total cholesterol (190.73 ± 44.13 vs. 175.27 ± 37.67 mg/dl, p = 0.035) and high-density lipoprotein (47.53 ± 14.25 vs. 40.92 ± 13.17 mg/dl, p = 0.007) than the dolutegravir group. For a Kg/m2 increase in BMI and for each month's increase in the duration of HIV, the patients were 66% (AOR = 1.66, 95% CI: 1.13, 2.44), and 13% (AOR = 1.13, 95% CI: 1.03, 1.23) more likely to have hyperglycemia, respectively. In contrast, female patients were 3.04 times more likely to have dyslipidemia (AOR = 3.03, 95% CI: 1.14, 8.05) as compared to male patients, and with an increase in CD4 cell count of 1 cell/mm3, the odds of dyslipidemia increased by 0.3% (AOR = 1.003, 95% CI: 1.001, 1.006). CONCLUSION Efavirenz-based therapy resulted in higher mean values of total cholesterol and high-density lipoprotein as compared with dolutegravir-based therapy. It is important to consider and evaluate high-density lipoprotein levels in HIV patients on dolutegravir-based therapy, and total cholesterol levels in people living with HIV on efavirenz-based therapy.
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Affiliation(s)
- Mohammed Jemal
- Department of Biomedical Science, School of Medicine, Debre Markos University, Debre Markos, Ethiopia
| | - Tewodros Shibabaw Molla
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | - Markeshaw Tiruneh G. Medhin
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
| | | | - Tadesse Asmamaw Dejenie
- Department of Biochemistry, School of Medicine, College of Medicine & Health Sciences, University of Gondar, Gondar, Ethiopia
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Su X, Luo R, Ruan S, Zhong Q, Zhuang Z, Xiao Z, Zhang P, Cheng B, Gong T, Ji C. Efficacy and tolerability of oral upadacitinib monotherapy in patients with recalcitrant vitiligo. J Am Acad Dermatol 2023; 89:1257-1259. [PMID: 37516357 DOI: 10.1016/j.jaad.2023.07.1016] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/04/2023] [Accepted: 07/08/2023] [Indexed: 07/31/2023]
Affiliation(s)
- Xinhong Su
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Renwei Luo
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Shifan Ruan
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Qingmei Zhong
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zheyu Zhuang
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Zhixun Xiao
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Peng Zhang
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Bo Cheng
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China
| | - Ting Gong
- Central Laboratory, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
| | - Chao Ji
- Department of Dermatology, The First Affiliated Hospital of Fujian Medical University, Fuzhou, Fujian, China.
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Rocabert A, Borjabad B, Berrocal L, Blanch J, Inciarte A, Chivite I, Gonzalez-Cordon A, Torres B, Ambrosioni J, Martinez-Rebollar M, Laguno M, De La Mora L, Foncillas A, Sempere A, Rodriguez A, Solbes E, Llobet R, Miro JM, Mallolas J, Blanco JL, De Lazzari E, Martinez E. Tolerability of bictegravir/tenofovir alafenamide/emtricitabine versus dolutegravir/lamivudine as maintenance therapy in a real-life setting. J Antimicrob Chemother 2023; 78:2961-2967. [PMID: 37875023 DOI: 10.1093/jac/dkad338] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2023] [Accepted: 10/11/2023] [Indexed: 10/26/2023] Open
Abstract
BACKGROUND While both the burden of therapy and the individual drugs in bictegravir/tenofovir alafenamide/emtricitabine (BIC/TAF/FTC) and dolutegravir/lamivudine differ, it is unclear whether their real-life tolerability may be also different. METHODS Single-centre, clinical cohort analysis of all virologically suppressed persons with HIV (PWH) who were first prescribed bictegravir as BIC/TAF/FTC or dolutegravir as dolutegravir/lamivudine and had taken ≥1 dose of study medication. Major outcomes were discontinuations either for any reason or due to toxicity. Incidence was calculated as number of episodes per 100 person-years adjusted through propensity score analysis. RESULTS Relative to persons treated with BIC/TAF/FTC (n = 1231), persons treated with dolutegravir/lamivudine (n = 821) were older and had more AIDS-defining conditions although better HIV control. After a median follow-up of 52 weeks, adjusted incidence rates for discontinuation were 6.68 (95% CI 5.18-8.19) and 8.44 (95% CI 6.29-10.60) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.26 (95% CI 0.89-1.78) relative to BIC/TAF/FTC (P = 0.1847). Adjusted incidence rates for discontinuation due to toxicity were 3.88 (95% CI 2.70-5.06) and 4.62 (95% CI 3.05-6.19) episodes per 100 person-years for BIC/TAF/FTC and dolutegravir/lamivudine, respectively; adjusted incidence rate ratio for dolutegravir/lamivudine was 1.19 (95% CI 0.75-1.90) relative to BIC/TAF/FTC (P = 0. 4620). Adverse events leading to discontinuation were neuropsychiatric (n = 42; 2%), followed by gastrointestinal (n = 23; 1%), dermatological (n = 15; 1%) and weight increase (n = 15; 1%), without differences between regimens. CONCLUSIONS Switching to BIC/TAF/FTC or dolutegravir/lamivudine showed no difference in the risks of overall or toxicity-related discontinuations or in the profile of adverse events leading to discontinuation.
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Affiliation(s)
- Alba Rocabert
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Beatriz Borjabad
- Service of Internal Medicine, Hospital Moises Broggi, Sant Joan Despí, Spain
| | - Leire Berrocal
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jordi Blanch
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Alexy Inciarte
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ivan Chivite
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | | | - Berta Torres
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Juan Ambrosioni
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Maria Martinez-Rebollar
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Montserrat Laguno
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | | | | | - Abiu Sempere
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Ana Rodriguez
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Estela Solbes
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Roger Llobet
- Hospital Clínic, University of Barcelona, Barcelona, Spain
| | - Jose M Miro
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Josep Mallolas
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Jose L Blanco
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Elisa De Lazzari
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
| | - Esteban Martinez
- Hospital Clínic, University of Barcelona, Barcelona, Spain
- CIBER de Enfermedades Infecciosas (CIBERINFEC), Instituto de Salud Carlos III, Madrid, Spain
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Lahiri CD, Mehta CC, Sykes C, Weiser SD, Palella F, Lake JE, Mellors JW, Gustafson D, French AL, Adimora AA, Konkle-Parker D, Sharma A, Bolivar H, Kassaye SG, Rubin LH, Alvarez JA, Golub ET, Ofotokun I, Sheth AN. Obesity Modifies the Relationship Between Raltegravir and Dolutegravir Hair Concentrations and Body Weight Gain in Women Living with HIV. AIDS Res Hum Retroviruses 2023; 39:644-651. [PMID: 37140468 PMCID: PMC10712367 DOI: 10.1089/aid.2022.0185] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/05/2023] Open
Abstract
Integrase strand-transfer inhibitors (INSTIs) are associated with weight gain in women living with HIV (WLH). Relationships between drug exposure, baseline obesity, and INSTI-associated weight gain remain unclear. Data from 2006 to 2016 were analyzed from virally suppressed WLH enrolled in the Women's Interagency HIV Study, who switched/added an INSTI to antiretroviral therapy: [raltegravir (RAL), dolutegravir (DTG), or elvitegravir (EVG)]. Percent body weight change was calculated from weights obtained a median 6 months pre-INSTI and 14 months post-INSTI initiation. Hair concentrations were measured with validated liquid chromatography-mass spectrometry (MS)/MS assays. Baseline (preswitch) weight status evaluated obese (body mass index, BMI, ≥30 kg/m2) versus nonobese (BMI <30 kg/m2). Mixed models examined the drug hair concentration*baseline obesity status interaction for each INSTI. There were 169 WLH included: 53 (31%) switched to RAL, 72 (43%) to DTG, and 44 (26%) to EVG. Women were median age 47-52 years, predominantly Non-Hispanic Black, median CD4 counts >500 cells/mm3, >75% with undetectable HIV-1 RNA. Over ∼1 year, women experienced median increases in body weight: 1.71% (-1.78, 5.00) with RAL; 2.40% (-2.82, 6.50) with EVG; and 2.48% (-3.60, 7.88) with DTG. Baseline obesity status modified the relationship between hair concentrations and percent weight change for DTG and RAL (p's < 0.05): higher DTG, yet lower RAL concentrations were associated with greater weight gain among nonobese women. Additional pharmacologic assessments are needed to understand the role of drug exposure in INSTI-associated weight gain.
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Affiliation(s)
- Cecile D. Lahiri
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - C. Christina Mehta
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Craig Sykes
- Clinical Pharmacology and Analytical Chemistry Core, Eshelman School of Pharmacy, University of North Carolina, Chapel Hill, North Carolina, USA
| | - Sheri D. Weiser
- Division of HIV, Infectious Diseases, and Global Medicine, Department of Medicine, University of California San Francisco School of Medicine, San Francisco, California, USA
| | - Frank Palella
- Division of Infectious Diseases, Department of Medicine, Feinberg School of Medicine, Chicago, Illinois, USA
| | - Jordan E. Lake
- Division of Infectious Diseases, Department of Medicine, University of Texas Health Science Center at Houston, Houston, Texas, USA
| | - John W. Mellors
- Division of Infectious Diseases, Department of Medicine, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania, USA
| | - Deborah Gustafson
- Department of Neurology, State University of New York Downstate Health Sciences University, Brooklyn, New York, USA
| | - Audrey L. French
- Division of Infectious Diseases, CORE Center/Stroger (Cook County) Hospital, Chicago, Illinois, USA
| | - Adaora A. Adimora
- Division of Infectious Diseases, Department of Medicine, University of North Carolina School of Medicine, Chapel Hill, North Carolina, USA
| | - Deborah Konkle-Parker
- Division of Infectious Diseases, Department of Medicine, University of Mississippi School of Medicine, Jackson, Mississippi, USA
| | - Anjali Sharma
- Department of Medicine, Albert Einstein College of Medicine, Bronx, New York, USA
| | - Hector Bolivar
- Division of Infectious Diseases, Department of Medicine, University of Miami Health System, Miami, Florida, USA
| | - Seble G. Kassaye
- Division of Infectious Diseases, Department of Medicine, Georgetown University Medical Center, Washington, District of Columbia, USA
| | - Leah H. Rubin
- Departments of Neurology, Psychiatry and Behavioral Sciences, and Molecular and Comparative Pathobiology, School of Medicine, Johns Hopkins University, Baltimore, Maryland, USA
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Jessica A. Alvarez
- Division of Endocrinology, Metabolism, and Lipids, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Elizabeth T. Golub
- Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, Maryland, USA
| | - Igho Ofotokun
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
| | - Anandi N. Sheth
- Division of Infectious Diseases, Department of Medicine, Emory University School of Medicine, Atlanta, Georgia, USA
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Guttman-Yassky E, Silverberg JI, Thaçi D, Papp KA, Ständer S, Beck LA, Kim BS, Hu X, Liu J, Calimlim BM, Vigna N, Crowley JT, Teixeira HD, Thyssen JP. Upadacitinib treatment withdrawal and retreatment in patients with moderate-to-severe atopic dermatitis: Results from a phase 2b, randomized, controlled trial. J Eur Acad Dermatol Venereol 2023; 37:2558-2568. [PMID: 37528500 DOI: 10.1111/jdv.19391] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2023] [Accepted: 06/30/2023] [Indexed: 08/03/2023]
Abstract
BACKGROUND Atopic dermatitis (AD) is a chronic inflammatory skin disease characterized by pruritic eczematous lesions. The effect of treatment withdrawal after response to upadacitinib oral treatment is not fully characterized. OBJECTIVES Assess the effect of upadacitinib withdrawal on skin clearance and itch improvement in adult patients with moderate-to-severe AD and evaluate the kinetics of recovery on rescue treatment. METHODS Data from a phase 2b randomized, placebo-controlled trial (NCT02925117) of upadacitinib in patients with moderate-to-severe AD were analysed. Patients were randomized 1:1:1:1 to receive upadacitinib 7.5 mg, 15 mg, 30 mg or placebo, and then at Week 16, patients were re-randomized 1:1 to receive the same dose of upadacitinib (upadacitinib 30 mg for patients initialized to placebo) or placebo. From Week 20, those who experienced loss of response defined as Eczema Area and Severity Index <50% improvement from baseline (EASI 50) received rescue treatment with upadacitinib 30 mg. RESULTS Patients who withdrew from upadacitinib experienced a rapid loss of skin clearance response, while those who switched from placebo to upadacitinib gained response. Loss of skin clearance response occurred within 4 weeks and worsening of itch occurred within 5 days. In patients who originally received placebo or a lower dose of upadacitinib leading to a loss of EASI response, rescue treatment with upadacitinib 30 mg resulted in rapid recovery or improvement of both skin and itch responses; most patients who were re-randomized to placebo achieved EASI 75 and IGA 0/1 by 8 weeks of rescue treatment. No new safety risks were observed. CONCLUSIONS Continuous treatment with upadacitinib is suggested to maintain skin clearance and antipruritic effects.
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Affiliation(s)
- Emma Guttman-Yassky
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Jonathan I Silverberg
- Department of Dermatology, The George Washington University School of Medicine and Health Sciences, Washington, District of Columbia, USA
| | - Diamant Thaçi
- Institute and Comprehensive Center Inflammation Medicine, University of Lübeck, Lübeck, Germany
| | - Kim A Papp
- Probity Medical Research and K Papp Clinical Research, Waterloo, Ontario, Canada
| | - Sonja Ständer
- Department of Dermatology and Center for Chronic Pruritus, University Hospital Münster, Münster, Germany
| | - Lisa A Beck
- Department of Dermatology, University of Rochester Medical Center, Rochester, New York, USA
| | - Brian S Kim
- Department of Dermatology, Icahn School of Medicine at Mount Sinai, New York, New York, USA
| | - Xiaofei Hu
- AbbVie, Inc, North Chicago, Illinois, USA
| | | | | | | | | | | | - Jacob P Thyssen
- Department of Dermatology and Venereology, Bispebjerg Hospital, University of Copenhagen, Hellerup, Denmark
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Liu H, He S, Yang T, Lu C, Yao Y, Zhou R, Yin K, He Y, Cheng J. Tolerability and effectiveness of albuvirtide combined with dolutegravir for hospitalized people living with HIV/AIDS. Medicine (Baltimore) 2023; 102:e35344. [PMID: 37960773 PMCID: PMC10637561 DOI: 10.1097/md.0000000000035344] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Accepted: 08/21/2023] [Indexed: 11/15/2023] Open
Abstract
Treatment options for hospitalized people living with HIV/AIDS (PLWHA) with opportunistic infections and comorbidities are limited in China. Albuvirtide (ABT), a new peptide drug, is a long-acting HIV fusion inhibitor with limited drug-drug interactions and fast onset time. This single-center, retrospective cohort study investigated the effectiveness and safety of ABT plus dolutegravir (DTG) therapy in a real-world setting. We performed a chart review on the electronic patient records for hospitalized PLWHA using ABT plus DTG between April and December 2020. The clinical outcomes were retrospectively analyzed. Among 151 PLWHA (mean age 47.6 ± 15.9 years), 140 (93%) had at least 1 episode of bacterial and/or fungal infections and 64 (42%) had other comorbidities including syphilis, hepatitis B, and/or hypertension. ABT plus DTG was given to 87 treatment-naïve (TN) and 64 treatment-experienced (TE) PLWHA. Regardless of treatment history, mean HIV-1 RNA levels significantly decreased from 4.32 log10copies/mL to 2.24 log10copies/mL, 2.10 log10copies/mL and 1.89 log10copies/mL after 2, 4 and 8 weeks of treatment, respectively (P < .0001). Compared with baseline mean CD4 + T-cell counts of 122.72 cells/μL, it increased to 207.87 cells/μL (P = .0067) and 218.69 cells/μL (P = .0812) after 4 and 8 weeks of treatment. Except for limited laboratory abnormalities such as hyperuricemia, increased creatinine level, and hyperglycemia observed after treatment, no other clinical adverse events were considered related to ABT plus DTG. Data suggests that ABT plus DTG is safe and effective for critically-ill hospitalized PLWHA. In view of the rapid viral load suppression and restoration of CD4 + count within 8 weeks of treatment, its clinical application warrants further investigation.
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Affiliation(s)
- Huanxia Liu
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Shenghua He
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Tongtong Yang
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Chunrong Lu
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Yuan Yao
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Ruifeng Zhou
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Ke Yin
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Yuanhong He
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
| | - Jing Cheng
- Clinical Section 1, Department of Infectious Disease, Public Health Clinical Center of Chengdu, Chengdu, China
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Mulindwa F, Castelnuovo B, Brusselaers N, Bollinger R, Yendewa G, Amutuhaire W, Mukashaka C, Schwarz JM. Should dolutegravir always be withheld in people with HIV on dolutegravir with incident diabetes mellitus? a case report. BMC Infect Dis 2023; 23:744. [PMID: 37904127 PMCID: PMC10617153 DOI: 10.1186/s12879-023-08712-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2023] [Accepted: 10/14/2023] [Indexed: 11/01/2023] Open
Abstract
Dolutegravir (DTG), an integrase strand transfer inhibitor is currently the recommended first and second line anti-retroviral therapy (ART) anchor agent by the World Health Organization due to its favorable side effect profile, high efficacy and genetic barrier to resistance.Despite its very good side effect profile, there have been multiple case reports of ART experienced patients developing hyperglycemia within weeks to a few months after switching to DTG preceded by weight loss. At population level, however, DTG as well as other integrase inhibitors have been demonstrated to have a reduced risk of incident diabetes mellitus (T2DM) compared to other HIV drug classes.Following multiple similar reports of accelerated hyperglycemia in Uganda during the first pilot year of DTG use, the Uganda Ministry of Health recommended withholding dolutegravir in all patients who develop diabetes. Whether this recommendation should be applied to all patients with incident T2DM remains to be demonstrated.We present a clinical case of an HIV positive ART naïve man who was diagnosed with T2DM after 36 weeks on DTG. We describe changes in blood glucose, glycated hemoglobin, insulin resistance and pancreatic beta cell function before and after withholding DTG. We demonstrated that he was phenotypically different from the reported cases of accelerated hyperglycemia and he continued to have worsening insulin resistance despite withholding DTG. His blood glucose improved with dietary T2DM management. It is possible he had an inherent risk of developing T2DM independent of his exposure to DTG. This put in question whether DTG should universally be withheld in PLHIV with incident T2DM in Uganda.
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Affiliation(s)
- Frank Mulindwa
- Capacity Building Unit, Makerere University Infectious Diseases Institute, Kampala, Uganda.
- Global Health Institute, Antwerp University, Antwerp, Belgium.
| | - Barbara Castelnuovo
- Capacity Building Unit, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Nele Brusselaers
- Global Health Institute, Antwerp University, Antwerp, Belgium
- Centre for Translational Microbiome Research, Department of Microbiology, Tumour and Cell Biology, Karolinska University, Stockholm, Sweden
| | | | - George Yendewa
- Department of Internal Medicine, Case Western Reserve University, Cleveland, USA
| | | | - Claudine Mukashaka
- Capacity Building Unit, Makerere University Infectious Diseases Institute, Kampala, Uganda
| | - Jean-Marc Schwarz
- School of Medicine, University of California San Francisco, San Francisco, USA
- Department of Basic Sciences, Touro University California College of Osteopathic Medicine, Vallejo, CA, USA
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30
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Pérez-Barragán E, Guevara-Maldonado MF, Mancilla-Galindo J, Kammar-García A, Ortiz-Hernández A, Mata-Marín JA, Pérez-Cavazos S. Weight Gain After 12 Months of Switching to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Virologically Suppressed HIV Patients. AIDS Res Hum Retroviruses 2023; 39:511-517. [PMID: 37071218 DOI: 10.1089/aid.2022.0130] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/19/2023] Open
Abstract
Recent studies suggest that the introduction of antiretroviral agents such as integrase strand transfer inhibitors (INSTI) may lead to weight gain in people living with HIV (PLHIV). In this retrospective observational study, we report the weight changes observed in virologically suppressed HIV patients after 12 months of switching to bictegravir/emtricitabine/tenofovir alafenamide (BIC/F/TAF) due to a national change in public policy in Mexico. Patients on prior regimens based on TDF/FTC or ABC/3TC plus non-nucleoside retrotranscriptase inhibitor, INSTI, or protease inhibitor were included. In the 399 patients analyzed, a significant weight increase was found, as well as an increase in body mass index (BMI), total cholesterol, low-density lipoprotein cholesterol (LDL-C), glucose, creatinine, and CD4+ cells after 12 months of switching treatment (all p ≤ .001). Mean weight gain was 1.63 kg [confidence interval (95% CI): 1.14-2.11], whereas the average percentage of weight gained was 2.5% (95% CI: 1.83-3.17). After considering the confounding effect of baseline weight status, the change in weight and BMI did not present significant differences between any of the prior treatment schemes. In conclusion, PLHIV switching to BIC/F/TAF therapy experienced weight gain after the first year of switching treatment. Although this weight gain could be due to the switch in treatment regimen, it cannot be excluded that it was caused by other factors since no comparable control group could be used for comparison.
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Affiliation(s)
- Edgar Pérez-Barragán
- Servicio de Infectología, Hospital General de Zona N° 48, Ciudad de México, México
| | | | - Javier Mancilla-Galindo
- División de Posgrado, Facultad de Medicina, Universidad Nacional Autónoma de México, Ciudad de México, México
| | - Ashuin Kammar-García
- Dirección de Investigación, Instituto Nacional de Geriatría, Ciudad de México, México
| | | | - José Antonio Mata-Marín
- Servicio de Infectología, Hospital de Infectología, Centro Médico Nacional La Raza, Ciudad de México, México
| | - Samantha Pérez-Cavazos
- Departamento de Epidemiología Hospitalaria/Servicio de Infectología, Hospital Christus Muguerza Betania, Puebla, México
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Lagi F, Giacomelli A, Borghi V, Ciccullo A, Taramasso L, Madeddu G, D'Ettorre G, Giacometti A, Ducci F, De Vito A, Pincino R, Di Giambenedetto S, Mussini C, Antinori S, Sterrantino G. Efficacy and tolerability of dolutegravir/lamivudine versus dolutegravir/rilpivirine in switching from a three-drug regimen based on nonnucleoside reverse transcriptase inhibitors: A retrospective cohort study. J Med Virol 2023; 95:e29149. [PMID: 37805832 DOI: 10.1002/jmv.29149] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 09/17/2023] [Accepted: 09/26/2023] [Indexed: 10/09/2023]
Abstract
Real-life comparisons of dolutegravir/rilpivirine (DTG/RPV) and DTG/lamivudine (3TC) regimens in people living with human immunodeficiency virus (PLWHIV) who switched from a standard three-drug regimen based on nonnucleoside reverse transcriptase inhibitors (NNRTIs) are missing. This study aimed to compare DTG/3TC and DTG/RPV in virologically suppressed patients (HIV-RNA < 50 copies/mL) coming from any NNRTI-based regimen in terms of discontinuation due to virologic failure (VF) discontinuation rates due to all causes, and adverse events. As a secondary outcome, we evaluated the difference in creatinine, total cholesterol, CD4, and triglycerides from baseline to weeks 48 after the switch. Of the 415 PLWHs included in the study, 278 (66.9%) switched to DTG/3TC, and 137 (33.1%) switched to DTG/RPV. Overall, 48 PLWHs (11.6%) discontinued the treatment:38 with DTG/3TC and 10 with DTG/RPV with similar discontinuation rates: 5.01 × 100 py (95% confidence interval [CI] 3.64-6.94) and 4.66 × 100 py (95% CI 2.51-8.67), respectively. The most common reason for discontinuation was toxicity (26 patients, 22/278 [7.9%] in the DTG/3TC group and 4/137 [2.9%] in the DTG/RPV group), mainly neurologic toxicity (never above grade 2). We found no differences in discontinuation rates due to treatment adverse events. Two study participants experienced virological failure in the DTG/3TC arm. We observed no significant difference in CD4 cell counts, lipid parameters, or renal function between the two groups at 48 weeks. This study demonstrated that, in clinical practice, a two-drug regimen with DTG/3TC or DTG/RPV is characterized by a low discontinuation rate and VF in virologically suppressed PLWHs switched from an NNRTI-based three antiretroviral drugs regimen.
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Affiliation(s)
- Filippo Lagi
- Infectious and Tropical Diseases Unit, Emergency Department, Careggi University Hospital, Florence, Italy
| | - Andrea Giacomelli
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
| | - Vanni Borghi
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Arturo Ciccullo
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Lucia Taramasso
- Infectious Diseases Unit, Department of Internal Medicine, Ospedale Policlinico San Martino - IRCCS, Genoa, Italy
| | - Giordano Madeddu
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Gabriella D'Ettorre
- Department of Public Health and Infectious Diseases, Policlinico Umberto I, Sapienza University, Rome, Italy
| | - Andrea Giacometti
- Institute of Infectious Diseases and Public Health, Department of Biological Sciences and Public Health, Università Politecnica delle Marche, Ancona, Italy
| | - Filippo Ducci
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
| | - Andrea De Vito
- Department of Medicine, Surgery and Pharmacy, Unit of Infectious Disease, University of Sassari, Sassari, Italy
| | - Rachele Pincino
- Department of Health Sciences (DISSAL), Infectious Diseases Unit, University of Genoa, Genoa, Italy
| | - Simona Di Giambenedetto
- Section of Infectious Diseases, Department of Safety and Bioethics, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy
| | - Cristina Mussini
- Department of Infectious Diseases, Azienda Ospedaliero, Universitaria Policlinico of Modena, Modena, Italy
| | - Spinello Antinori
- Department of Infectious Diseases, ASST Fatebenefratelli-Sacco, Milan, Italy
- Luigi Sacco Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy
| | - Gaetana Sterrantino
- Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy
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32
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Hagino T, Saeki H, Fujimoto E, Kanda N. Background factors predicting the occurrence of herpes zoster in atopic dermatitis patients treated with upadacitinib. J Dermatol 2023; 50:1301-1312. [PMID: 37401031 DOI: 10.1111/1346-8138.16879] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2023] [Revised: 05/30/2023] [Accepted: 06/14/2023] [Indexed: 07/05/2023]
Abstract
Upadacitinib, an oral Janus kinase 1 inhibitor approved for treating atopic dermatitis (AD), can cause adverse events such as herpes zoster (HZ) and acne. We aimed to identify background factors predicting the occurrence of HZ and acne during upadacitinib treatment in patients with AD. From August 2021 to December 2022, 112 Japanese patients with moderate-to-severe AD (aged ≥12 years) were treated with upadacitinib 15 mg/day (78 patients) or 30 mg/day (34 patients) plus topical corticosteroids or delgocitinib limited to head and neck for 3-9 months. AD patients with the occurrence of HZ during upadacitinib treatment had higher incidences for history of HZ and of bronchial asthma than those without in the upadacitinib 15 mg, 30 mg, and whole groups. AD patients with occurrence of HZ had higher pretreatment values of lactate dehydrogenase and eczema area and severity index on head and neck compared to those without in the upadacitinib 15 mg and whole groups. Logistic regression analysis revealed that history of HZ was associated with the occurrence of HZ in the upadacitinib 15 mg and whole groups. The proportion of underage patients (<18 years) was higher in patients with occurrence of acne compared to those without in the upadacitinib 30 mg group, but no significant differences were found in the other background factors between the two patient populations. History of HZ may predict the occurrence of HZ during upadacitinib treatment in patients with AD.
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Affiliation(s)
- Teppei Hagino
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
| | - Hidehisa Saeki
- Department of Dermatology, Nippon Medical School, Tokyo, Japan
| | | | - Naoko Kanda
- Department of Dermatology, Nippon Medical School Chiba Hokusoh Hospital, Inzai, Japan
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Chandasana H, Thapar M, Hayes S, Baker M, Gibb DM, Turkova A, Ford D, Ruel T, Wiznia A, Fairlie L, Bwakura-Dangarembizi M, Mujuru H, Alvero C, Farhad M, Hazra R, Townley E, Buchanan A, Bollen P, Waalewijn H, Colbers A, Burger D, Acosta EP, Singh R. Population Pharmacokinetic Modeling of Dolutegravir to Optimize Pediatric Dosing in HIV-1-Infected Infants, Children, and Adolescents. Clin Pharmacokinet 2023; 62:1445-1459. [PMID: 37603217 PMCID: PMC10520196 DOI: 10.1007/s40262-023-01289-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/17/2023] [Indexed: 08/22/2023]
Abstract
BACKGROUND AND OBJECTIVE HIV treatment options remain limited in children. Dolutegravir is a potent and well-tolerated, once-daily HIV-1 integrase inhibitor recommended for HIV-1 infection in both adults and children down to 4 weeks of age. To support pediatric dosing of dolutegravir in children, we used a population pharmacokinetic model with dolutegravir data from the P1093 and ODYSSEY clinical trials. The relationship between dolutegravir exposure and selected safety endpoints was also evaluated. METHODS A population pharmacokinetic model was developed with data from P1093 and ODYSSEY to characterize the pharmacokinetics and associated variability and to evaluate the impact of pharmacokinetic covariates. The final population pharmacokinetic model simulated exposures across weight bands, doses, and formulations that were compared with established adult reference data. Exploratory exposure-safety analyses evaluated the relationship between dolutegravir pharmacokinetic parameters and selected clinical laboratory parameters and adverse events. RESULTS A total of N = 239 participants were included, baseline age ranged from 0.1 to 17.5 years, weight ranged from 3.9 to 91 kg, 50% were male, and 80% were black. The final population pharmacokinetic model was a one-compartment model with first-order absorption and elimination, enabling predictions of dolutegravir concentrations in the pediatric population across weight bands and doses/formulations. The predicted geometric mean trough concentration was comparable to the adult value following a 50-mg daily dose of dolutegravir for all weight bands at recommended doses. Body weight, age, and formulation were significant predictors of dolutegravir pharmacokinetics in pediatrics. Additionally, during an exploratory exposure-safety analysis, no correlation was found between dolutegravir exposure and selected safety endpoints or adverse events. CONCLUSIONS The dolutegravir dosing in children ≥ 4 weeks of age on an age/weight-band basis provides comparable exposures to those historically observed in adults. Observed pharmacokinetic variability was higher in this pediatric population and no additional safety concerns were observed. These results support the weight-banded dosing of dolutegravir in pediatric participants currently recommended by the World Health Organization.
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Affiliation(s)
- Hardik Chandasana
- Clinical Pharmacology, Modeling and Simulation, GSK, 1250 South Collegeville Road, Collegeville, PA, 19406, USA.
| | | | | | | | - Diana M Gibb
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Anna Turkova
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Deborah Ford
- Medical Research Council Clinical Trials Unit at University College London, London, UK
| | - Theodore Ruel
- University of California, San Francisco, San Francisco, CA, USA
| | - Andrew Wiznia
- Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, NY, USA
| | - Lee Fairlie
- Faculty of Health Sciences, Wits RHI, University of the Witwatersrand, Johannesburg, South Africa
| | | | - Hilda Mujuru
- Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | | | - Mona Farhad
- Frontier Science Foundation, Brookline, MA, USA
| | - Rohan Hazra
- Eunice Kennedy Shriver National Institute of Child Health and Human Development, National Institutes of Health, Bethesda, MD, USA
| | - Ellen Townley
- National Institute of Allergy and Infectious Diseases, National Institutes of Health, Bethesda, MD, USA
| | | | - Pauline Bollen
- Department of Pharmacy, Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Hylke Waalewijn
- Department of Pharmacy, Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - Angela Colbers
- Department of Pharmacy, Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | - David Burger
- Department of Pharmacy, Radboudumc Institute for Medical Innovation, Radboud University Medical Center, Nijmegen, The Netherlands
| | | | - Rajendra Singh
- Clinical Pharmacology, Modeling and Simulation, GSK, 1250 South Collegeville Road, Collegeville, PA, 19406, USA
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Palich R, Hentzien M, Hocqueloux L, Duvivier C, Allavena C, Huleux T, Makinson A, Rey D, Delobel P, Cuzin L. Country of birth is associated with discrepancies in the prescription of two-drug regimens in successfully treated people with HIV in France. AIDS 2023; 37:1891-1896. [PMID: 37451430 DOI: 10.1097/qad.0000000000003657] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 07/18/2023]
Abstract
OBJECTIVES We aimed to examine the association of the country of birth and the other patients' characteristics with the prescription of two-drug regimens (2DRs) in virally suppressed people with HIV (PWH) in France. DESIGN Observational study conducted from the national Dat'AIDS prospectively collected database. METHODS We included all adults who were actively in care on 31 December 2020 in 26 French centers, with an HIV plasma viral load (pVL) <50 copies/ml for at least 6 months while on antiretroviral therapy (ART). Patients with chronic hepatitis B were excluded because they are not eligible to 2DRs. Univariate and multivariate logistic regressions were built to analyze relationships between patients' characteristics and receiving a 2DR. RESULTS We analyzed data from 28 395 PWH: 41.7% men who have sex with men, 31.7% women and 26.5% heterosexual men; 35% born abroad. Median age was 53 years [interquartile range (IQR) 44-60]; ART duration 14 years (8-23); duration of virological suppression 87 months (42-142). 2DRs (mainly dolutegravir/rilpivirine, 53.8%, or dolutegravir/lamivudine, 41.7%) were prescribed in 16.3% of the patients and were less common in the 'born abroad' group (18.9% versus 11.5%). The multivariate model showed that individuals born in France were more likely to receive a 2DR [adjusted odds ratio (aOR): 1.62 [1.50-1.74]], independently of other characteristics. Older PLWH and those with higher CD4 + T-cell counts were also more likely to receive a 2DR. CONCLUSION Despite unrestricted access to ART in France, independently from HIV disease parameters, PWH born abroad were less likely to receive 2DRs as a maintenance regimen than those born in France. Qualitative data are needed to better understand physicians' prescribing practices.
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Affiliation(s)
- Romain Palich
- Sorbonne University, Infectious Diseases Department, Pitié-Salpêtrière Hospital, AP-HP, Pierre Louis Epidemiology and Public Health Institute (iPLESP), INSERM 1136, Paris
| | - Maxime Hentzien
- Infectious Diseases, Internal Medicine and Clinical Immunology Department, Centre Hospitalier Universitaire Robert Debré, Reims
| | - Laurent Hocqueloux
- Infectious Diseases Department, Centre Hospitalier Régional d'Orléans, Orléans
| | - Claudine Duvivier
- AP-HP-Necker Hospital, Infectious Diseases Department, Necker-Pasteur Infectiology Center; University Paris Cité, INSERM U1016, CNRS UMR8104, Institut Cochin; IHU Imagine, Institut Pasteur, Institut Pasteur Medical Center, Paris
| | | | - Thomas Huleux
- Infectious and Travel Diseases Department, Tourcoing University Hospital, Tourcoing
| | - Alain Makinson
- University of Montpellier, Infectious Diseases and Tropical department, University Hospital Montpellier, Montpellier
| | - David Rey
- HIV Infection Care Center, Strasbourg University Hospital, Strasbourg
| | - Pierre Delobel
- University of Toulouse Paul Sabatier, Infectious and Tropical Diseases Department, Toulouse University Hospital, Toulouse
| | - Lise Cuzin
- CERPOP, Toulouse University, INSERM UMR1295, UPS, Toulouse, France; Martinique University Hospital, Infectious and Tropical Diseases, Fort de France, France
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Ismail M, Doelger E, Eckert D, Irvine AD, Chu AD, Teixeira HD, Liu W, Nader A. Population pharmacokinetic and exposure-response modelling to inform upadacitinib dose selection in adolescent and adult patients with atopic dermatitis. Br J Clin Pharmacol 2023; 89:3139-3151. [PMID: 37232215 DOI: 10.1111/bcp.15803] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2023] [Revised: 05/09/2023] [Accepted: 05/18/2023] [Indexed: 05/27/2023] Open
Abstract
AIMS First, population pharmacokinetic analyses were used to characterize upadacitinib pharmacokinetics in adolescent and adult participants with atopic dermatitis (AD) and to identify patient covariates that may impact upadacitinib pharmacokinetics. Second, the exposure-response relationship for upadacitinib with efficacy and safety endpoints, and the effect of age and concomitant use of topical corticosteroids (TCS) on the exposure-response relationship and dose selection for patients with AD were evaluated. METHODS A two-compartment model with combined first- and zero-order absorption adequately characterized the upadacitinib concentration-time profiles in 911 healthy volunteer adolescent and adult participants with AD who received upadacitinib 15 or 30 mg orally once daily (QD) as monotherapy or in combination with TCS for 16 weeks. Logistic regression models were developed to characterize the exposure-efficacy and safety relationships, and simulations were performed based on final exposure-response models to predict efficacy responses in participants with AD who received placebo or upadacitinib as monotherapy or in combination with TCS. RESULTS Upadacitinib exposures were comparable between adolescents and adults. Mild or moderate renal impairment was predicted to increase the upadacitinib area under the plasma concentration-time curve from time zero to 24 h after dosing (AUC24 ) approximately 12% and 25%, respectively, compared to participants with normal renal function. Female participants were predicted to have 20% higher AUC24 compared to male participants. Participants with AD were predicted to have 18% higher AUC24 compared to healthy participants. Simulated clinical efficacy responses showed added clinical efficacy benefit for all endpoints evaluated (8-14%) with the upadacitinib 30 mg once-daily regimen compared to 15 mg once-daily in both age groups. In participants receiving upadacitinib in combination with TCS, significant exposure-dependent increases in upadacitinib efficacy endpoints were observed. No significant effects of age or weight were identified in any of the exposure-response models. CONCLUSION The results of these analyses support the dose justification for upadacitinib in adult and adolescent patients with moderate to severe AD.
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Affiliation(s)
- Mohamed Ismail
- Clinical Pharmacology, AbbVie Inc., Chicago, Illinois, USA
| | - Eva Doelger
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | - Doerthe Eckert
- Clinical Pharmacology, AbbVie Deutschland GmbH & Co KG, Ludwigshafen, Germany
| | - Alan D Irvine
- Clinical Medicine, Trinity College Dublin, University of Dublin, Dublin, Ireland
- Wellcome-HRB Clinical Research Facility, St James' Hospital, Dublin, Ireland
| | - Alvina D Chu
- Immunology Clinical Development, AbbVie Inc., Chicago, Illinois, USA
| | | | - Wei Liu
- Clinical Pharmacology, AbbVie Inc., Chicago, Illinois, USA
| | - Ahmed Nader
- Clinical Pharmacology, AbbVie Inc., Chicago, Illinois, USA
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Mendoza I, Lázaro A, Espinosa A, Sánchez L, Horta AM, Torralba M. Effectiveness, durability and safety of dolutegravir and lamivudine versus bictegravir, emtricitabine and tenofovir alafenamide in a real-world cohort of HIV-infected adults. PLoS One 2023; 18:e0291480. [PMID: 37773939 PMCID: PMC10540944 DOI: 10.1371/journal.pone.0291480] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2023] [Accepted: 08/24/2023] [Indexed: 10/01/2023] Open
Abstract
OBJECTIVE Dolutegravir plus lamivudine (2-DR) is suggested as an initial and switch option in HIV-1 treatment. The aim of this study was to analyze the effectiveness, durability, and safety of 2-DR compared to bictegravir/emtricitabine/tenofovir alafenamide (3-DR). PATIENTS AND METHODS This was an observational, ambispective study that included all treatment-naïve (TN) and treatment-experienced (TE) people living with HIV/AIDS (PLWH), who started 2-DR or 3-DR between 01 July 2018, and 31 January 2022. The primary endpoint was non-inferiority, at 24 and 48 weeks, of 2-DR vs 3-DR regarding the percentage of PLWH with viral load (VL)<50 and 200 copies/mL in TN (12% margin) and VL≥50 and 200 copies/mL in TE (4% margin). Durability of response and safety were also measured. RESULTS 292 PLWH were included (39 TN and 253 TE). In TN PLWH, non-inferiority was not achieved at 24 weeks (17; 95% CI -17 to 51 p = 0.348). By week 48, all PLWH on 3-DR maintained VL<50 copies/mL compared to 70% of PLWH on 2-DR although without reaching statistical significance (-33; 95% CI -60 to -10 p = 0.289). Non-inferiority was not achieved in TE PLWH either at 24 (0.4; 95% CI -9 to 10 p = 1) or at 48 weeks (4.5; 95% CI -0.5 to 9 p = 0.132). In TN, the risk of treatment discontinuation was similar between groups (HR: 0.31, p = 0.07); similar rates were also found in TE (HR: 1.3, p = 0.38). TE PLWH on 2-DR showed a better safety profile compared to 3-DR (p = 0.017). CONCLUSION Our results did not show non-inferiority in terms of virological effectiveness. Additionally, durability and safety of 2-DR were confirmed to be similar to 3-DR.
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Affiliation(s)
- Inés Mendoza
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Alcalá University, Alcalá de Henares, Spain
| | - Alicia Lázaro
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Alfredo Espinosa
- Internal Medicine Department, Research Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Lorenzo Sánchez
- Internal Medicine Department, Research Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain
| | - Ana María Horta
- Pharmacy Department, Hospital Universitario de Guadalajara, Guadalajara, Spain
- Alcalá University, Alcalá de Henares, Spain
| | - Miguel Torralba
- Alcalá University, Alcalá de Henares, Spain
- Internal Medicine Department, Research Unit, Hospital Universitario de Guadalajara, Guadalajara, Spain
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Baraliakos X, van der Heijde D, Sieper J, Inman RD, Kameda H, Li Y, Bu X, Shmagel A, Wung P, Song IH, Deodhar A. Efficacy and safety of upadacitinib in patients with ankylosing spondylitis refractory to biologic therapy: 1-year results from the open-label extension of a phase III study. Arthritis Res Ther 2023; 25:172. [PMID: 37723577 PMCID: PMC10506267 DOI: 10.1186/s13075-023-03128-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Accepted: 07/29/2023] [Indexed: 09/20/2023] Open
Abstract
BACKGROUND Upadacitinib, a Janus kinase inhibitor, has demonstrated efficacy and an acceptable safety profile in patients with ankylosing spondylitis (AS) in the phase III SELECT-AXIS programs. We report the 1-year efficacy and safety in patients with AS and an inadequate response to biologic disease-modifying antirheumatic drugs (bDMARD-IR) from the SELECT-AXIS 2 study. METHODS Patients ≥ 18 years with active AS who met the modified New York criteria for AS and were bDMARD-IR received double-blind upadacitinib 15 mg once daily (QD) or placebo for 14 weeks. Patients who completed 14 weeks could enter an open-label extension and receive upadacitinib 15 mg QD for up to 2 years. Efficacy endpoints included the percentage of patients achieving ≥ 40% improvement in Assessment of SpondyloArthritis international Society response (ASAS40), Ankylosing Spondylitis Disease Activity Score (ASDAS) low disease activity (LDA), and ASDAS inactive disease (ID); and change from baseline in total and nocturnal back pain, and Bath Ankylosing Spondylitis Functional Index (BASFI). Subgroup analyses (bDMARD lack of efficacy versus intolerance, and prior tumor necrosis factor inhibitor [TNFi] versus interleukin-17 inhibitor [IL-17i] exposure) were conducted. Binary and continuous efficacy endpoints were assessed using non-responder imputation with multiple imputation (NRI-MI) and as observed (AO) analyses; and mixed-effects model repeated measures (MMRM) and AO, respectively. Safety was assessed based on adverse events. Data through week 52 are reported. RESULTS Of 420 randomized patients, 366 (continuous upadacitinib: n = 181; placebo to upadacitinib: n = 185) completed 52 weeks of treatment. At week 52, in the continuous upadacitinib and placebo to upadacitinib groups, ASAS40, ASDAS LDA, and ASDAS ID were achieved by 66% and 65%, 57% and 55%, and 26% and 25% (all NRI-MI); and change from baseline in total back pain, nocturnal back pain, and BASFI was -4.5 and -4.3, -4.6 and -4.4, and -3.6 and -3.5 (all MMRM), respectively. No new safety risks were identified. Subgroup analyses were consistent with the overall study population. CONCLUSIONS Upadacitinib 15 mg QD demonstrated sustained improvement up to 52 weeks in bDMARD-IR patients with AS. Efficacy was generally similar in patients with lack of efficacy versus intolerance to bDMARDs and prior TNFi versus IL-17i exposure. TRIAL REGISTRATION NCT02049138.
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Affiliation(s)
| | | | - Joachim Sieper
- Gastroenterology, Infectious Diseases and Rheumatology, Charité Universitätsmedizin Berlin, Berlin, Germany
| | - Robert D Inman
- Schroeder Arthritis Institute, University Health Network, and University of Toronto, Toronto, ON, Canada
| | | | - Yihan Li
- AbbVie Inc, North Chicago, IL, USA
| | | | | | | | | | - Atul Deodhar
- Division of Arthritis & Rheumatic Diseases, Oregon Health & Science University, Portland, OR, USA
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Pacheco P, Marques N, Rodrigues P, Mansinho K, Maltez F, Janeiro N, Franco C, Trigo D, Batista J, Duque L, Lopes MJ, Aleixo MJ, Silva AR, Tavares R, Alves J, Peres S, Póvoas D, Lino S, Gomes P, Araújo V, Lopes C. Safety and Efficacy of Triple Therapy With Dolutegravir Plus 2 Nucleoside Reverse Transcriptase Inhibitors in Treatment-Naive Human Immunodeficiency Virus Type 2 Patients: Results From a 48-Week Phase 2 Study. Clin Infect Dis 2023; 77:740-748. [PMID: 37288954 DOI: 10.1093/cid/ciad339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 03/30/2023] [Accepted: 05/31/2023] [Indexed: 06/09/2023] Open
Abstract
BACKGROUND Integrase strand transfer inhibitor-based regimens are recommended for first-line therapy in human immunodeficiency virus type 2 (HIV-2). Nonetheless, dolutegravir (DTG) clinical trial data are lacking. METHODS We conducted a phase 2, single-arm, open-label trial to evaluate the safety and efficacy of a triple therapy regimen that included DTG in persons with HIV-2 (PWHIV-2) in Portugal. Treatment-naive adults receive DTG in combination with 2 nucleoside reverse transcriptase inhibitors (NRTIs). Treatment efficacy was evaluated by the proportion of patients who achieved a plasma viral load (pVL) <40 copies/mL and/or by the change from baseline in CD4+ T-cell count and in CD4/CD8 ratio at week 48. RESULTS A total of 30 patients were enrolled (22 women; median age, 55 years). At baseline, 17 (56.7%) individuals were viremic (median, pVL 190 copies/mL; interquartile range [IQR], 99-445). The median CD4 count was 438 cells/μL (IQR, 335-605), and the CD4/CD8 ratio was 0.8. Three patients discontinued the study. At week 48, all participants (27) had pVL <40 copies/mL. No virological failures were observed. Mean changes in CD4 count and CD4/CD8 ratio at week 48 were 95.59 cells/µL (95% confidence interval [CI], 28-163) and 0.32 (95% CI, .19 to .46). The most common drug-related adverse events were headache and nausea. One participant discontinued due to central nervous system symptoms. No serious adverse events were reported. CONCLUSIONS DTG plus 2 NRTIs is safe and effective as first-line treatment for PWHIV-2 with a tolerability profile previously known. No virological failures were observed that suggest a high potency of DTG in HIV-2 as occurs in HIV-1. CLINICAL TRIALS REGISTRATION M NCT03224338.
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Affiliation(s)
- Patrícia Pacheco
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Nuno Marques
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Paulo Rodrigues
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Kamal Mansinho
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Fernando Maltez
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Nuno Janeiro
- Infectious Diseases Department, Hospital Santa Maria, Lisboa, Portugal
| | - Cláudia Franco
- Infectious Diseases Department, Hospital Santa Maria, Lisboa, Portugal
| | - Diva Trigo
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Joana Batista
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Luís Duque
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Maria João Lopes
- Infectious Diseases Department, Hospital Professor Doutor Fernando Fonseca, Amadora, Portugal
| | - Maria João Aleixo
- Infectious Diseases Department, Hospital Garcia de Orta, Almada, Portugal
| | - Ana Rita Silva
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - Raquel Tavares
- Infectious Diseases Department, Hospital Beatriz Ângelo, Loures, Portugal
| | - João Alves
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Susana Peres
- Infectious Diseases Department, Hospital Egas Moniz, Lisboa, Portugal
| | - Diana Póvoas
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Sara Lino
- Infectious Diseases Department, Hospital Curry Cabral, Lisboa, Portugal
| | - Perpétua Gomes
- Molecular Biology Laboratory, Hospital Egas Moniz, Lisboa, Portugal
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Gelato F, Mastorino L, Quaglino P, Cavaliere G, Ortoncelli M, Ribero S. Ocular Adverse Events in Patients With Atopic Dermatitis Treated With Upadacitinib: A Real-Life Experience. Dermatitis 2023; 34:445-447. [PMID: 36917522 DOI: 10.1089/derm.2022.0063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Background: Dupilumab, an interleukin (IL)-4 receptor-α inhibitor that blocks IL-4 and IL-13 signaling pathways, is an effective and well-tolerated therapy for moderate-to-severe atopic dermatitis (AD). However, an increased incidence of dupilumab-associated conjunctivitis has been reported in patients treated with dupilumab. In contrast, upadacitinib, a selective Janus kinase 1 inhibitor, is reported to have lower incidence of conjunctivitis than dupilumab. Objective: The aim of this retrospective study was to investigate ocular adverse events in adult patients with moderate-to-severe AD treated with upadacitinib after discontinuing treatment with dupilumab. Methods: In total, 33 patients were examined at the start of treatment with upadacitinib after discontinuation of dupilumab, then again after 4 weeks and every 12 weeks up to a maximum of 72 weeks. Results: Among the patients in the study, 14 had developed dupilumab-associated conjunctivitis during dupilumab treatment and had complete resolution of ocular symptoms after the switch to upadacitinib within the 1-month follow-up visit. In addition, only 1 patient treated with upadacitinib developed an episode of conjunctivitis. This condition was of mild severity and it spontaneously resolved quickly. Interestingly, this patient had no history of dupilumab-associated conjunctivitis. Conclusions: All patients who developed dupilumab-associated conjunctivitis experienced complete remission on upadacitinib and only 3% of the patients in our sample developed conjunctivitis after the start of treatment with upadacitinib. In light of this, upadacitinib appears to be a prudent and safe treatment option for AD patients with uncontrolled ocular symptoms associated with dupilumab therapy.
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Affiliation(s)
- Federica Gelato
- From the *Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Luca Mastorino
- From the *Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Pietro Quaglino
- From the *Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Giovanni Cavaliere
- From the *Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Michela Ortoncelli
- From the *Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
| | - Simone Ribero
- From the *Dermatology Clinic, Department of Medical Sciences, University of Turin, Turin, Italy
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Dontsova V, Mohan H, Blanco C, Jao J, Greene NDE, Copp AJ, Zash R, Serghides L. Metabolic implications and safety of dolutegravir use in pregnancy. Lancet HIV 2023; 10:e606-e616. [PMID: 37549681 DOI: 10.1016/s2352-3018(23)00141-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2022] [Revised: 06/05/2023] [Accepted: 06/09/2023] [Indexed: 08/09/2023]
Abstract
Dolutegravir is recommended for all people living with HIV because of its efficacy, high barrier to resistance, favourable safety and tolerability profile, and affordability. Dolutegravir has the highest rates of viral suppression in pregnancy, therefore preventing perinatal HIV transmission. In view of these benefits, particularly for pregnant women, an important question is if dolutegravir is safe in pregnancy. Dolutegravir has been associated with metabolic complications, including weight gain and rare events of hyperglycaemia, that could affect maternal, fetal, and postnatal health. We review the current clinically and experimentally based literature on the implications of dolutegravir use for pregnant women and for developing embryos and fetuses. Possible effects on folate status, energy metabolism, adipogenesis, and oxidative stress are considered. In many instances, insufficient data are available, pointing to the need for additional research in this important area of HIV treatment.
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Affiliation(s)
- Valeriya Dontsova
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Haneesha Mohan
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Camille Blanco
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada
| | - Jennifer Jao
- Department of Pediatrics, Division of Pediatric Infectious Diseases, Northwestern University Feinberg School of Medicine, Chicago, IL, USA
| | - Nicholas D E Greene
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Andrew J Copp
- Developmental Biology and Cancer Department, UCL Great Ormond Street Institute of Child Health, University College London, London, UK
| | - Rebecca Zash
- Department of Medicine, Division of Infectious Disease, Beth Israel Deaconess Medical Center, Boston, USA
| | - Lena Serghides
- Toronto General Hospital Research Institute, University Health Network, Toronto, ON, Canada; Women's College Research Institute, Women's College Hospital, Toronto, ON, Canada; Department of Immunology and Institute of Medical Sciences, University of Toronto, Toronto, ON, Canada.
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Palmier E, De Miguel R, Montejano R, Busca C, Micán R, Ramos L, Cadiñanos J, Serrano L, Bernardino JI, Pérez-Valero I, Valencia E, Arribas JR, Montes ML, González-García J, Martín-Carbonero L. Three-year efficacy of switching to dolutegravir plus lamivudine: A real-world study. HIV Med 2023; 24:1013-1019. [PMID: 37194419 DOI: 10.1111/hiv.13500] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2023] [Accepted: 04/18/2023] [Indexed: 05/18/2023]
Abstract
BACKGROUND Dolutegravir (DTG) plus lamivudine (3TC) has proven highly efficacious as a switching strategy in virologically suppressed people with HIV (PWH). As this strategy was introduced relatively recently, real-world, long-term durability studies are lacking. METHODS We performed a retrospective review of treatment-experienced patients who started DTG + 3TC in a cohort of PWH. HIV-RNA <50 copies/mL was analysed at 144 weeks in an intention-to-treat (ITT) analysis (missing = failure) and a per-protocol (PP) analysis (patients with missing data or changes for reasons other than virological failure were excluded). RESULTS The study population comprised 358 PWH (19% women). Median age and time with HIV infection were 51.7 and 13.4 years, respectively. The median number of previous antiretroviral combinations was three. Previous virological failure was reported in 27.1% of patients, and the M184V resistance mutation was detected in 17 patients. At 144 weeks, the percentage of individuals with HIV-RNA <50 copies/mL was 77.4% (277/358) in the ITT analysis and 95.5% (277/290) in the PP analysis. A total of 68 participants were excluded from the PP analysis (data missing, 25, discontinuation due to toxicity, 19; other, 16; death, 8). Two people with virological failure selected resistance-associated mutations (M184V and M184V + R263K). HIV-RNA remained undetectable in 17 patients with a previous history of the M184V mutation. CONCLUSION Our results confirm the real-world, long-term efficacy, tolerability and high genetic barrier of DTG + 3TC in treatment-experienced PWH. Although scarce, mutations causing resistance to nucleosides and integrase can emerge.
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Affiliation(s)
- E Palmier
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - R De Miguel
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - R Montejano
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - C Busca
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - R Micán
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - L Ramos
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J Cadiñanos
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - L Serrano
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J I Bernardino
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | | | - E Valencia
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
| | - J R Arribas
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - M L Montes
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
| | - J González-García
- Hospital Universitario La Paz, IdiPaz, Madrid, Spain
- CIBER Infectious Diseases (CIBERINFEC), Madrid, Spain
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Fleischmann R, Curtis JR, Charles-Schoeman C, Mysler E, Yamaoka K, Richez C, Palac H, Dilley D, Liu J, Strengholt S, Burmester G. Safety profile of upadacitinib in patients at risk of cardiovascular disease: integrated post hoc analysis of the SELECT phase III rheumatoid arthritis clinical programme. Ann Rheum Dis 2023; 82:1130-1141. [PMID: 37308218 PMCID: PMC10423494 DOI: 10.1136/ard-2023-223916] [Citation(s) in RCA: 5] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/23/2023] [Accepted: 05/17/2023] [Indexed: 06/14/2023]
Abstract
OBJECTIVE Increased risk of serious adverse events (AEs) was reported for tofacitinib relative to tumour necrosis factor inhibitor therapy in patients with rheumatoid arthritis (RA) aged ≥50 years enriched for cardiovascular (CV) risk (ORAL Surveillance). We assessed post hoc the potential risk of upadacitinib in a similar RA population. METHODS Pooled safety data from six phase III trials were evaluated post hoc for AEs in patients receiving upadacitinib 15 mg once a day (with or without conventional synthetic disease-modifying antirheumatic drugs), adalimumab 40 mg every other week with concomitant methotrexate (MTX), or MTX monotherapy in the overall trial population and in a subset of patients with higher CV risk (aged ≥50 years, ≥1 CV risk factor). Higher-risk patients from a head-to-head study of upadacitinib 15 mg versus adalimumab (SELECT-COMPARE) were assessed in parallel. Exposure-adjusted incidence rates for treatment-emergent AEs were summarised based on exposure to upadacitinib or comparators. RESULTS A total of 3209 patients received upadacitinib 15 mg, 579 received adalimumab and 314 received MTX monotherapy; ~54% of the patients were included in the overall and SELECT-COMPARE higher-risk populations. Major adverse cardiovascular events (MACE), malignancy (excluding non-melanoma skin cancer (NMSC)) and venous thromboembolism (VTE) were more frequent in the higher-risk cohorts versus the overall population but were generally similar across treatment groups. Rates of serious infections in higher-risk populations and herpes zoster (HZ) and NMSC in all populations were higher with upadacitinib 15 mg than comparators. CONCLUSIONS An increased risk of MACE, malignancy (excluding NMSC) and VTE was observed in higher-risk populations with RA, yet risk was comparable between upadacitinib-treated and adalimumab-treated patients. Higher rates of NMSC and HZ were observed with upadacitinib versus comparators across all populations, and increased rates of serious infections were detected in upadacitinib-treated patients at higher CV risk. TRIAL REGISTRATION NUMBERS NCT02706873, NCT02675426, NCT02629159, NCT02706951, NCT02706847 and NCT03086343.
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Affiliation(s)
- Roy Fleischmann
- Department of Medicine, The University of Texas Southwestern Medical Center, Dallas, Texas, USA
| | - Jeffrey R Curtis
- Department of Medicine, The University of Alabama at Birmingham, Birmingham, Alabama, USA
| | - Christina Charles-Schoeman
- Department of Medicine, Division of Rheumatology, University of California Los Angeles, Los Angeles, California, USA
| | - Eduardo Mysler
- Organización Medica de Investigación, Buenos Aires, Argentina
| | - Kunihiro Yamaoka
- Department of Rheumatology and Infectious Diseases, Kitasato University School of Medicine, Sagamihara, Japan
| | - Christophe Richez
- University Bordeaux, CNRS, ImmunoConcEpT, UMR 5164, and CHU of Bordeaux, Department of Rheumatology, Bordeaux, France
| | | | | | | | | | - Gerd Burmester
- Department of Rheumatology and Clinical Immunology, Charité Universitätsmedizin Berlin, Berlin, Germany
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Mazzitelli M, Sasset L, Gardin S, Leoni D, Trunfio M, Scaglione V, Mengato D, Agostini E, Vania E, Putaggio C, Cattelan A. Real-Life Experience on Dolutegravir and Lamivudine as Initial or Switch Therapy in a Silver Population Living with HIV. Viruses 2023; 15:1740. [PMID: 37632082 PMCID: PMC10459453 DOI: 10.3390/v15081740] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2023] [Revised: 08/08/2023] [Accepted: 08/10/2023] [Indexed: 08/27/2023] Open
Abstract
BACKGROUND Clinical trials and real-life studies have granted the efficacy and safety of dolutegravir and lamivudine (DTG/3TC) in naïve and experienced people living with HIV (PLWH), but there are no long-term data in elderly people. We herein describe our real-life cohort of PLWH who were ≥65 years of age (PLWH ≥ 65) who started or were switched to DTG/3TC, single-tablet regimen, or DTG plus 3TC. METHODS We considered laboratory/clinical parameter changes from the baseline to the last follow-up time point available for each person by the paired Wilcoxon test and analyzed factors associated with virological failure (VF) and discontinuation. RESULTS We included 112 PLWH with a median age of 66 (IQR: 65-70) years, 77.6% males; 84.8% of people had multimorbidity, 34.8% were on polypharmacy, and only 5.4% were naïve to treatment. Reasons to be switched to DTG/3TC were: abacavir removal (38.7%), treatment simplification (33.1%), and PI discontinuation (28.2%). The median treatment durability was 6 (IQR: 5.4-7) years. No significant changes were detected in metabolic, renal, immunological, or cardiovascular biomarkers during follow-up. HIV RNA undetectability was maintained in 104 (92.8%) individuals for whom follow-up evaluation was available. We observed eight discontinuations (two deaths, two VFs, two early intolerances, one significant weight gain, and one switch to long-acting therapy). No factors were significantly associated with VF or discontinuation. CONCLUSIONS This is the first study on DTG/3TC in PLWH ≥ 65 with a follow-up longer than 5 years. DTG/3TC was found to be safe and effective, neutral on metabolic parameters, and with a low discontinuation rate for toxicity or VF.
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Affiliation(s)
- Maria Mazzitelli
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Lolita Sasset
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Samuele Gardin
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Davide Leoni
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Mattia Trunfio
- Infectious Diseases Unit, Department of Medical Sciences, University of Turin, Amedeo di Savoia Hospital, 10149 Turin, Italy;
- HIV Neurobehavioral Research Program, Departments of Neurosciences and Psychiatry, School of Medicine, University of California, San Diego, CA 92093, USA
| | - Vincenzo Scaglione
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Daniele Mengato
- Hospital Pharmacy Unit, Padua University Hospital, 35128 Padua, Italy
| | - Elena Agostini
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Eleonora Vania
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
- Infectious Disease Unit, Department of Medicine, University of Udine, 33100 Udine, Italy
| | - Cristina Putaggio
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
| | - Annamaria Cattelan
- Infectious and Tropical Diseases Unit, Padua University Hospital, 35128 Padua, Italy
- Department of Molecular Medicine, University of Padua, 35131 Padua, Italy
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Palacios R, Gómez-Ayerbe C, Casado JL, Tejerina F, Montes ML, Castaño M, Ocampo A, Rial D, Ribera E, Galindo MJ, Hidalgo C, Fariñas C, Montero M, Payeras T, Fanjul F, de la Torre J, Santos J. Efficacy and safety of dolutegravir/rilpivirine in real-world clinical practice. GeSIDA study 1119. HIV Med 2023; 24:933-937. [PMID: 37016556 DOI: 10.1111/hiv.13489] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2022] [Accepted: 03/14/2023] [Indexed: 04/06/2023]
Abstract
INTRODUCTION Dolutegravir/rilpivirine (DTG/RPV) is an effective antiretroviral (ART) regimen endorsed by clinical trials as a switch therapy. The aim of our study was to analyse the efficacy and safety of DTG/RPV in real-world clinical practice. METHODS Observational, multicentre study of patients who started DTG/RPV. Efficacy, adverse events and metabolic changes at 48 weeks were analysed. RESULTS A total of 348 patients were included; median time of HIV infection was 21.1 years, 33.7% were AIDS cases; median nadir CD4 was 160 cells/μL; 90.5% had received ≥3 lines of ART and 179 (53.8%) had prior virological failure. Convenience (43.5%), toxicity/intolerance (28.4%) and interactions (17.0%) were the main reasons for starting DTG/RPV. Previous regimens were protease inhibitors (PI) (31.6%), non-nucleoside reverse transcriptase inhibitors (NNRTI) (20.4%) and integrase strand transfer inhibitors (INSTI) (14.9%). Efficacy (HIV-RNA <50 copies/mL) at 48 weeks was 89.7% (95% CI 86.1-92.6) by intention-to-treat (ITT) and 94.2% (95% CI 91.3-96.4) by on treatment (OT); 10 patients (3.1%) were not suppressed (3 had abandoned ART). There was a mean decrease in triglycerides, total cholesterol, low-density lipoprotein-cholesterol, glutamic-pyruvic transaminase (GPT), gamma-glutamyl transferase (GGT) and alkaline phosphatase; creatinine increased with a decrease in glomerular filtration rate. CONCLUSIONS This study confirms the effectiveness, tolerability and safety of DTG/RPV in real-world clinical practice in a different population from clinical trials, with many years of infection, low CD4 nadir, several previous treatment lines, more than half with virological failures, and one-third diagnosed with AIDS. The switch to DTG/RPV was safe with few discontinuations due to adverse effects. Modifications of the lipid and liver profiles were favourable. There were no relevant changes in kidney function.
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Affiliation(s)
- R Palacios
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - C Gómez-Ayerbe
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
| | - J L Casado
- Hospital Universitario Ramón y Cajal, Madrid, Spain
| | - F Tejerina
- Hospital General Universitario Gregorio Marañón, Madrid, Spain
| | - M L Montes
- Hospital Universitario La Paz, Madrid, Spain
| | - M Castaño
- Hospital Regional Universitario de Málaga, Málaga, Spain
| | - A Ocampo
- Hospital Alvaro Cunqueiro, Vigo, Spain
| | - D Rial
- Hospital Universitario 12 de Octubre, Madrid, Spain
| | - E Ribera
- Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - M J Galindo
- Hospital General de Valencia, Valencia, Spain
| | - C Hidalgo
- Hospital Universitario Virgen de las Nieves, Granada, Spain
| | - C Fariñas
- Hospital Universitario Marqués de Valdecilla, Santander, Spain
| | - M Montero
- Hospital Universitario La Fe, Valencia, Spain
| | - T Payeras
- Hospital Son Llàtzer, Palma de Mallorca, Spain
| | - F Fanjul
- Hospital Universitari Son Espaces, Palma de Mallorca, Spain
| | | | - J Santos
- Hospital Universitario Virgen de la Victoria, Málaga, Spain
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Nasreddine R, Florence E, Yombi JC, Henrard S, Darcis G, Van Praet J, Vandekerckhove L, Allard SD, Demeester R, Messiaen P, Ausselet N, Delforge M, De Wit S. Efficacy, durability, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide for the treatment of HIV in a real-world setting in Belgium. HIV Med 2023; 24:914-924. [PMID: 37038245 DOI: 10.1111/hiv.13493] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/26/2022] [Accepted: 03/20/2023] [Indexed: 04/12/2023]
Abstract
OBJECTIVES Our objective was to evaluate the efficacy, durability, and tolerability of bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF) in a real-world setting in Belgium. METHODS This was a retrospective, multicentre cohort study involving adult treatment-naïve (TN) and treatment-experienced (TE) people living with HIV receiving BIC/FTC/TAF between 1 January 2019 and 30 September 2020. The primary outcome was rate of virological suppression (plasma HIV-1 viral load <50 copies/mL; on-treatment analysis) at weeks 24 and 48. The main secondary outcomes included loss of virological suppression (LVS; two consecutive viral loads of >200 copies/mL after being virologically suppressed) by week 48 and analysis of resistance-associated mutations at time of LVS; tolerability of BIC/FTC/TAF over the 48-week study period; and change in weight and proportion of participants reporting a >10% weight gain at week 48. RESULTS Overall, 2001 participants were included. Through 48 weeks, overall rate of virological suppression was 93.5%, with similar results observed in the following subgroups: age ≥50 years (92.7%), women (92.8%), Black sub-Saharan African (91%), TN (94%), TE (93.2%), and non-suppressed at baseline (86.6%). LVS was observed in 0.7% (n = 14) of participants, with one participant developing resistance-associated mutations to nucleoside reverse transcriptase inhibitors (184 V) and integrase strand transfer inhibitors (263KR). Of the 131 (6.5%) treatment discontinuations, the most common reason was an adverse event (2.4%), with the most frequent being central nervous system/psychiatric (0.4%) and gastrointestinal (0.4%) toxicity. Median weight gain at week 48 was 2 kg (interquartile range -1 to 5), and a >10% weight increase was observed in 11.6% of participants. CONCLUSION In this large real-world cohort, BIC/FTC/TAF showed excellent virological efficacy in a diverse population of patients with HIV. Rare occurrence of emergent drug resistance was observed, and treatment was well tolerated.
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Affiliation(s)
| | | | | | - Sophie Henrard
- University Clinics of Brussels - Erasme Hospital, Brussels, Belgium
| | | | | | | | | | - Rémy Demeester
- University Hospital of Charleroi, Lodelinsart, Charleroi, Belgium
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Bacha JM, Dlamini S, Anabwani F, Gwimile J, Kanywa JB, Farirai J, Bvumbwe M, Tsotako M, Steffy T, Nguyen D, Mendez-Reyes JE, Elyanu P, Haq H. Realizing the Promise of Dolutegravir in Effectively Treating Children and Adolescents Living With HIV in Real-world Settings in 6 Countries in Eastern and Southern Africa. Pediatr Infect Dis J 2023; 42:576-581. [PMID: 36795586 PMCID: PMC10259212 DOI: 10.1097/inf.0000000000003878] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/15/2023] [Indexed: 02/17/2023]
Abstract
BACKGROUND Despite encouraging results from clinical trials and in high-income countries, large-scale data on the effectiveness and safety of dolutegravir (DTG) in children and adolescents living with HIV (CALHIV) are lacking in low- and middle-income countries (LMICs). METHODS Retrospective analysis was performed among CALHIV 0-19 years old and weighing greater than or equal to 20 kg who received DTG from 2017 to 2020 at sites in Botswana, Eswatini, Lesotho, Malawi, Tanzania and Uganda to determine effectiveness, safety and predictors of viral load suppression (VLS) among CALHIV using DTG, including through single drug substitutions (SDS). RESULTS Among 9419 CALHIV using DTG, 7898 had a documented post-DTG VL, and VLS post-DTG was 93.4% (7378/7898). VLS for antiretroviral therapy (ART) initiations was 92.4% (246/263), and VLS was maintained for the ART-experienced [92.9% (7026/7560) pre- vs. 93.5% (7071/7560) post-DTG; P = 0.14). Among previously unsuppressed, 79.8% (426/534) achieved VLS with DTG. Only 5 patients reported a Grade 3 or 4 adverse event (0.057 per 100 patient-years) requiring DTG discontinuation. History of protease inhibitor-based ART [odds ratio (OR) = 1.53; 95% confidence interval (CI): 1.16-2.03], care in Tanzania (OR = 5.45; 95% CI: 3.41-8.70), and being 15-19 years old (OR = 1.31; 95% CI: 1.03-1.65) were associated with gain of VLS post-DTG. Predictors of VLS on DTG included VLS before DTG (OR = 3.87; 95% CI: 3.03-4.95) and using the once-daily, single tab tenofovir-lamivudine-DTG regimen (OR = 1.78; 95% CI: 1.43-2.22). SDS maintained VLS [95.9% (2032/2120) pre- vs. 95.0% (2014/2120) post-SDS with DTG; P = 0.19], and 83.0% (73/88) of unsuppressed gained VLS using SDS with DTG. CONCLUSIONS We found DTG to be highly effective and safe within our cohort of CALHIV in LMICs. These findings can empower clinicians to prescribe DTG confidently to eligible CALHIV.
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Affiliation(s)
- Jason Michael Bacha
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine Children’s Foundation - Tanzania, Mbeya, Tanzania
| | - Sandile Dlamini
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine Children’s Foundation - Eswatini, Mbabane, Eswatini
| | - Florence Anabwani
- Baylor College of Medicine Children’s Foundation - Eswatini, Mbabane, Eswatini
| | - Judith Gwimile
- Baylor College of Medicine Children’s Foundation - Tanzania, Mwanza, Tanzania
| | | | - John Farirai
- Botswana-Baylor Children’s Clinical Centre of Excellence Trust, Gaborone, Botswana
| | - Menard Bvumbwe
- Baylor College of Medicine Children’s Foundation - Malawi, Lilongwe, Malawi
| | - Mabene Tsotako
- Baylor College of Medicine Children’s Foundation – Lesotho, Maseru, Lesotho
| | - Teresa Steffy
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine Children’s Foundation – Lesotho, Maseru, Lesotho
| | - Diane Nguyen
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
- Department of Education, Innovation, and Technology, Baylor College of Medicine, Houston, Texas
| | - Jose Euberto Mendez-Reyes
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Texas Children’s Hospital, Houston, Texas
| | - Peter Elyanu
- Baylor College of Medicine Children’s Foundation - Uganda, Kampala, Uganda
| | - Heather Haq
- From the Department of Pediatrics, Baylor College of Medicine, Houston, Texas
- Baylor College of Medicine International Pediatric AIDS Initiative (BIPAI) at Texas Children’s Hospital, Baylor College of Medicine, Houston, Texas
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Mehta R, Lagishetty CV, Angelis K, Aylott A, Kahl L, Blair L, Matthews J, Wynne B, Crauwels H, Underwood M, Adkison KK. Pharmacokinetic and pharmacokinetic/pharmacodynamic characterization of the dolutegravir/rilpivirine two-drug regimen in SWORD-1/-2 phase 3 studies. Br J Clin Pharmacol 2023; 89:2190-2200. [PMID: 36740580 DOI: 10.1111/bcp.15683] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2022] [Revised: 12/19/2022] [Accepted: 01/14/2023] [Indexed: 02/07/2023] Open
Abstract
AIM SWORD-1 and SWORD-2 phase 3 studies concluded that switching virologically suppressed participants with HIV-1 from their current three- or four-drug antiretroviral regimen (CAR) to the two-drug regimen of once-daily dolutegravir (DTG, 50 mg) and rilpivirine (RPV, 25 mg) was safe, well tolerated and noninferior for maintaining HIV-1 suppression at week 48 and highly efficacious to week 148. A secondary objective was to characterize drug exposure and exposure-efficacy/safety relationships. METHODS Adults with plasma HIV-1 RNA <50 copies/mL were randomized to switch to once-daily DTG + RPV on day 1 or to continue CAR for 52 weeks before switching. Trough plasma concentrations (C0) of DTG and RPV, the proportion of participants with HIV-1 RNA <50 copies/mL and adverse events to week 100 were summarized and subjected to exposure-response analyses in the overall population, in the subset of participants who switched from CAR containing enzyme-inducing drugs and by age category (≥50 and <50 years). The relationship between C0avg (individual average C0 across visits) and efficacy/safety was investigated. RESULTS Although week 2 DTG and RPV C0 were lower in participants switching from enzyme-inducing antiretroviral drugs, C0 and C0avg stayed above in vitro antiviral protein binding-adjusted IC90 and to week 100 with viral suppression >89%. DTG or RPV C0avg showed no relationship with virologic failures or safety. Participants ≥50 years had similar C0avg and safety response to younger participants. CONCLUSION No clinically relevant relationship between DTG or RPV exposures and virologic or safety response was observed, confirming the DTG + RPV switch for participants as a safe and effective treatment.
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Affiliation(s)
| | | | | | | | | | - Libby Blair
- ViiV Healthcare, Durham, North Carolina, USA
| | | | - Brian Wynne
- ViiV Healthcare, Durham, North Carolina, USA
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Griesel R, Zhao Y, Simmons B, Omar Z, Wiesner L, Keene CM, Hill AM, Meintjes G, Maartens G. Standard-dose versus double-dose dolutegravir in HIV-associated tuberculosis in South Africa (RADIANT-TB): a phase 2, non-comparative, randomised controlled trial. Lancet HIV 2023; 10:e433-e441. [PMID: 37230101 PMCID: PMC10322729 DOI: 10.1016/s2352-3018(23)00081-4] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 03/14/2023] [Accepted: 04/04/2023] [Indexed: 05/27/2023]
Abstract
BACKGROUND The drug-drug interaction between rifampicin and dolutegravir can be overcome by supplemental dolutegravir dosing, which is difficult to implement in high-burden settings. We aimed to test whether virological outcomes with standard-dose dolutegravir-based antiretroviral therapy (ART) are acceptable in people with HIV on rifampicin-based antituberculosis therapy. METHODS RADIANT-TB was a phase 2b, randomised, double-blind, non-comparative, placebo-controlled trial at a single site in Khayelitsha, Cape Town, South Africa. Participants were older than 18 years of age, with plasma HIV-1 RNA greater than 1000 copies per mL, CD4 count greater than 100 cells per μL, ART-naive or first-line ART interrupted, and on rifampicin-based antituberculosis therapy for less than 3 months. By use of permuted block (block size of 6) randomisation, participants were assigned (1:1) to receive either tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus supplemental 50 mg dolutegravir 12 h later or tenofovir disoproxil fumarate, lamivudine, and dolutegravir plus matched placebo 12 h later. Participants received standard antituberculosis therapy (rifampicin, isoniazid, pyrazinamide, and ethambutol for the first 2 months followed by isoniazid and rifampicin for 4 months). The primary outcome was the proportion of participants with virological suppression (HIV-1 RNA <50 copies per mL) at week 24 analysed in the modified intention-to-treat population. This study is registered with ClinicalTrials.gov, NCT03851588. FINDINGS Between Nov 28, 2019, and July 23, 2021, 108 participants (38 female, median age 35 years [IQR 31-40]) were randomly assigned to supplemental dolutegravir (n=53) or placebo (n=55). Median baseline CD4 count was 188 cells per μL (IQR 145-316) and median HIV-1 RNA was 5·2 log10 copies per mL (4·6-5·7). At week 24, 43 (83%, 95% CI 70-92) of 52 participants in the supplemental dolutegravir arm and 44 (83%, 95% CI 70-92) of 53 participants in the placebo arm had virological suppression. No treatment-emergent dolutegravir resistance mutations were detected up to week 48 in the 19 participants with study-defined virological failure. Grade 3 and 4 adverse events were similarly distributed between the study arms. The most frequent grade 3 and 4 adverse events were weight loss (4/108 [4%]), insomnia (3/108 [3%]), and pneumonia (3/108 [3%]). INTERPRETATION Our findings suggest that twice-daily dolutegravir might be unnecessary in people with HIV-associated tuberculosis. FUNDING Wellcome Trust.
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Affiliation(s)
- Rulan Griesel
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa.
| | - Ying Zhao
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Bryony Simmons
- LSE Health, London School of Economics and Political Science, London, UK
| | - Zaayid Omar
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Lubbe Wiesner
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Claire M Keene
- Médecins Sans Frontières, Cape Town, South Africa; Centre for Tropical Medicine and Global Health, Nuffield Department of Medicine, University of Oxford, Oxford, UK
| | - Andrew M Hill
- Department of Pharmacology and Therapeutics, University of Liverpool, Liverpool, UK
| | - Graeme Meintjes
- Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa; Department of Medicine, University of Cape Town, Cape Town, South Africa
| | - Gary Maartens
- Division of Clinical Pharmacology, Department of Medicine, University of Cape Town, Cape Town, South Africa; Wellcome Centre for Infectious Diseases Research in Africa, Institute of Infectious Disease and Molecular Medicine, and Department of Medicine, University of Cape Town, Cape Town, South Africa
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Rose PC, De la Rey Nel E, Cotton MF, Otwombe K, Browne SH, Frigati LJ, Rabie H, Innes S. Decreased Hepatic Steatosis in South African Adolescents With Perinatal HIV Switching to Dolutegravir-containing Regimens. Pediatr Infect Dis J 2023; 42:564-572. [PMID: 36917035 PMCID: PMC10257761 DOI: 10.1097/inf.0000000000003904] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 03/16/2023]
Abstract
BACKGROUND Although dolutegravir (DTG) has a favorable metabolic profile, it has been linked to excess weight gain. We evaluated changes in hepatic steatosis in adolescents with perinatally acquired HIV switching to DTG-containing antiretroviral therapy (ART). METHODS Virologically suppressed adolescents switched to dolutegravir for a minimum of 4 months or on unchanged ART (84% protease inhibitor) were assessed prospectively with anthropometry, transient elastography with controlled attenuation parameter (CAP) and fasting metabolic profiles. ART regimens were determined independently of the study. RESULTS In total 68 adolescents [baseline median age 13.5 years [interquartile range (IQR): 12.5-14.4 years]; 42 (62%) female] were recruited. However, 38 remained on the same regimen and were followed for a median of 98 weeks (IQR: 48-108 weeks), and 30 switched to DTG and were followed for a median of 52 weeks (IQR: 49-101). There was no baseline difference in CAP between groups. There was no significant change in body mass index z-score in either group, but the median CAP in the DTG group decreased by -40dB/m (IQR: -51 to -31 dB/m) after a median of 44 weeks (IQR: 28-50 weeks) on DTG, compared to +1dB/m (IQR: -29 to +14 dB/m) in adolescents not switched ( P < 0 .01). Cholesterol and triglycerides were lower in those switched. Whereas hepatic steatosis prevalence decreased from 17% to 3% in adolescents who switched to dolutegravir, its prevalence doubled from 8% to 16% in those not switched ( P = 0.1). CONCLUSIONS In this exploratory study, adolescents switched to DTG-containing regimens had reduced hepatic steatosis, cholesterol and triglycerides with no excess weight gain compared to those on unchanged ART.
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Affiliation(s)
- Penelope C. Rose
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Etienne De la Rey Nel
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Mark F. Cotton
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
- Family Center for Research with Ubuntu (FAMCRU), Cape Town, South Africa
| | - Kennedy Otwombe
- Perinatal HIV Research Unit, Chris Hani Baragwanath Academic Hospital, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
- School of Public Health, Faculty of Health Sciences, University of the Witwatersrand, Johannesburg, South Africa
| | - Sara H. Browne
- Department of Medicine, University of California San Diego
| | - Lisa J. Frigati
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Helena Rabie
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
| | - Steve Innes
- Department of Paediatrics and Child Health, Tygerberg Hospital and Stellenbosch University, Cape Town, South Africa
- Family Center for Research with Ubuntu (FAMCRU), Cape Town, South Africa
- Desmond Tutu HIV Centre, University of Cape Town, South Africa
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Loftus EV, Panés J, Lacerda AP, Peyrin-Biroulet L, D'Haens G, Panaccione R, Reinisch W, Louis E, Chen M, Nakase H, Begun J, Boland BS, Phillips C, Mohamed MEF, Liu J, Geng Z, Feng T, Dubcenco E, Colombel JF. Upadacitinib Induction and Maintenance Therapy for Crohn's Disease. N Engl J Med 2023; 388:1966-1980. [PMID: 37224198 DOI: 10.1056/nejmoa2212728] [Citation(s) in RCA: 53] [Impact Index Per Article: 53.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/26/2023]
Abstract
BACKGROUND Upadacitinib, an oral selective Janus kinase (JAK) inhibitor, is under investigation for the treatment of Crohn's disease. METHODS In two phase 3 induction trials (U-EXCEL and U-EXCEED), we randomly assigned patients with moderate-to-severe Crohn's disease to receive 45 mg of upadacitinib or placebo (2:1 ratio) once daily for 12 weeks. Patients who had a clinical response to upadacitinib induction therapy were randomly assigned in the U-ENDURE maintenance trial to receive 15 mg of upadacitinib, 30 mg of upadacitinib, or placebo (1:1:1 ratio) once daily for 52 weeks. The primary end points for induction (week 12) and maintenance (week 52) were clinical remission (defined as a Crohn's Disease Activity Index score of <150 [range, 0 to 600, with higher scores indicating more severe disease activity]) and endoscopic response (defined as a decrease in the Simple Endoscopic Score for Crohn's Disease [SES-CD; range, 0 to 56, with higher scores indicating more severe disease] of >50% from baseline of the induction trial [or for patients with an SES-CD of 4 at baseline, a decrease of ≥2 points from baseline]). RESULTS A total of 526 patients underwent randomization in U-EXCEL, 495 in U-EXCEED, and 502 in U-ENDURE. A significantly higher percentage of patients who received 45-mg upadacitinib than those who received placebo had clinical remission (in U-EXCEL, 49.5% vs. 29.1%; in U-EXCEED, 38.9% vs. 21.1%) and an endoscopic response (in U-EXCEL, 45.5% vs. 13.1%; in U-EXCEED, 34.6% vs. 3.5%) (P<0.001 for all comparisons). At week 52 in U-ENDURE, a higher percentage of patients had clinical remission with 15-mg upadacitinib (37.3%) or 30-mg upadacitinib (47.6%) than with placebo (15.1%), and a higher percentage had an endoscopic response with 15-mg upadacitinib (27.6%) or 30-mg upadacitinib (40.1%) than with placebo (7.3%) (P<0.001 for all comparisons). Herpes zoster infections occurred more frequently in the 45-mg and 30-mg upadacitinib groups than in the respective placebo groups, and hepatic disorders and neutropenia were more frequent in the 30-mg upadacitinib group than in the other maintenance groups. Gastrointestinal perforations developed in 4 patients who received 45-mg upadacitinib and in 1 patient each who received 30-mg or 15-mg upadacitinib. CONCLUSIONS Upadacitinib induction and maintenance treatment was superior to placebo in patients with moderate-to-severe Crohn's disease. (Funded by AbbVie; U-EXCEL, U-EXCEED, and U-ENDURE ClinicalTrials.gov numbers, NCT03345849, NCT03345836, and NCT03345823.).
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Affiliation(s)
- Edward V Loftus
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Julian Panés
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Ana P Lacerda
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Laurent Peyrin-Biroulet
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Geert D'Haens
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Remo Panaccione
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Walter Reinisch
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Edouard Louis
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Minhu Chen
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Hiroshi Nakase
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Jakob Begun
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Brigid S Boland
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Charles Phillips
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Mohamed-Eslam F Mohamed
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Jianzhong Liu
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Ziqian Geng
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Tian Feng
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Elena Dubcenco
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
| | - Jean-Frederic Colombel
- From the Division of Gastroenterology and Hepatology, Mayo Clinic College of Medicine and Science, Rochester, MN (E.V.L.); the Inflammatory Bowel Diseases Unit, Hospital Clinic Barcelona, Institut d'Investigacions Biomèdiques August Pi i Sunyer, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas, Barcelona (J.P.); AbbVie, North Chicago, IL (A.P.L., C.P., M-E.F.M., J.L., Z.G., T.F., E.D.); the Department of Gastroenterology and INSERM Unité 1256, Nutrition-Genetics and Environmental Risk Exposure, Faculty of Medicine, University Hospital of Nancy, Lorraine University, Vandoeuvre, France (L.P.-B.); the Department of Gastroenterology, Amsterdam University Medical Centers, Amsterdam (G.D.); the Inflammatory Bowel Disease Unit, Division of Gastroenterology and Hepatology, University of Calgary, Calgary, AB, Canada (R.P.); the Division of Gastroenterology and Hepatology, Medical University of Vienna, Vienna (W.R.); the Department of Hepato-Gastroenterology and Digestive Oncology, University Hospital Centre Hospitalier Universitaire of Liège, Liège, Belgium (E.L.); the Division of Gastroenterology, First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China (M.C.); the Department of Gastroenterology and Hepatology, Sapporo Medical University School of Medicine, Sapporo, Japan (H.N.); the Department of Gastroenterology, Mater Hospital Brisbane, Brisbane, QLD, Australia (J.B.); the Division of Gastroenterology, University of California, San Diego, La Jolla (B.B.); and the Henry D. Janowitz Division of Gastroenterology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York (J.-F.C.)
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