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Dravid AN, Pilawan AS, Anuradha S, Morkar DN, Ramapuram JT, Madhukarrao KM, Naik KS, Bhrusundi M, Raveendra K, Nageswaramma S, Kulkarni V. Safety of low dose efavirenz regimen in Indian adults with HIV-1 infection: Insights from a phase 4 interventional randomised trial. Medicine (Baltimore) 2023; 102:e35643. [PMID: 37933062 PMCID: PMC10627601 DOI: 10.1097/md.0000000000035643] [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: 07/12/2023] [Accepted: 09/22/2023] [Indexed: 11/08/2023] Open
Abstract
BACKGROUND A randomized interventional phase 4 study in the Indian population confirmed the non-inferiority of the combination tenofovir/lamivudine/efavirenz (TLE)-400 to TLE600. The current manuscript describes in detail the safety profile and patient-reported safety outcomes obtained from the phase 4 study. METHODS This investigation was part of a phase 4 non-inferiority study with a blinded assessment, conducted across 17 sites in India. The duration of the study was 24 weeks. Safety endpoints assessed included all the adverse events (AEs) related to the study treatment (TLE400 and TLE600). The depression anxiety stress 21-item scale questionnaire and efavirenz-related symptom questionnaire were also used to measure depression, anxiety, stress, and patient experience. RESULTS A total of 68 patients (52.3%) reported 261 AEs and 87 patients (64.9%) reported 379 AEs related to study treatment in TLE400 group and TLE600 group respectively, P = .037. The reported AEs associated with central nervous system disorders were lower in the TLE400 group with 41 patients (31.5%) to 61 patients (45.5%) in the TLE600 group. The change from mean baseline value for depression anxiety stress 21-item scale at week 28 in TLE400 group and TLE600 group was -5.1 and -6.2 respectively. Similarly, the mean change from baseline score of efavirenz-related symptoms at week 28 in TLE400 group and TLE600 group were -5.1 and -4.1 respectively. CONCLUSION The low dose efavirenz (400 mg) in combination with tenofovir and lamivudine had a better safety and tolerability profile than the standard dose of efavirenz (600 mg) in combination with tenofovir and lamivudine. Thus, low dose efavirenz should be preferred over the standard dose.
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Affiliation(s)
- Ameet N. Dravid
- Department of Medicine, Poona Hospital and Research Centre, Maharashtra, India
| | - Anant S. Pilawan
- Department of Medicine, Government Medical College & Hospital, Maharashtra, India
| | - S. Anuradha
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | | | | | | | - K. Sunil Naik
- Department of Medicine, Rajiv Gandhi Institute of Medical Science and RIMS Government General Hospital, Andhra Pradesh, India
| | - Milind Bhrusundi
- Department of Medicine, NKP Salve Institute of Medical Sciences and Late Mangeshkar Hospital, Maharashtra, India
| | - K.R. Raveendra
- Department of Medicine, Bangalore Medical College and Research Institute, Karnataka, India
| | | | - Vinay Kulkarni
- Department of Dermatology, Deenanath Mangeshkar Hospital and Research Centre, Maharashtra, India
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Dravid A, Pilawan AS, S. A, Morkar DN, Ramapuram JT, Madhukarrao KM, Naik KS, Bhrusundi M, K. R R, Nageswaramma S, Kulkarni V. Efficacy and safety of 400 mg efavirenz versus standard 600 mg dose when taken with tenofovir and lamivudine combination in Indian adult patients with HIV-1 infection: An open-label, interventional, randomized, non-inferiority trial. Medicine (Baltimore) 2022; 101:e31982. [PMID: 36482530 PMCID: PMC9726289 DOI: 10.1097/md.0000000000031982] [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] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND To evaluate the non-inferiority of low dose efavirenz (400 mg) to standard dose efavirenz (600 mg), when taken in combination with tenofovir and lamivudine in Indian patients with HIV-1 infection. METHODS An open-label, interventional phase IV study with blinded assessment was conducted across 17 sites in India. HIV-1-infected antiretroviral therapy-naive adult patients (≥18 years of age) with a plasma HIV-1 viral load of at least 1000 copies per mL were randomized to receive either tenofovir/lamivudine/efavirenz (TLE) 400 or TLE 600. The primary endpoint was the difference in the proportion of patients achieving < 200 copies per mL at the end of 24 weeks. RESULTS A total of 265 patients were enrolled and were randomized in 1:1 ratio to TLE 400 group (130 patients) and TLE 600 group (135 patients). At week 24, the proportion of patients with a viral load of less than 200 copies per mL was 80.70% for TLE 400 and 78.95% for TLE 600 (difference 1.75%, 90% confidence interval: -7.01, 10.49) which was within the predefined margin of -10% (90% confidence interval). Significantly lower study drug-related adverse events were observed in TLE 400 group compared to TLE 600 group (52.30%, n = 68 vs 64.92%, n = 87; P = .037). The treatment discontinuation percentage was marginally higher by 2.08% in TLE 600 group. CONCLUSION The fixed-dose combination of TLE 400 is non-inferior to TLE 600 in terms of viral suppression and has an improved safety profile over 24 weeks in adult Indian patients with HIV-1 infection.
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Affiliation(s)
- Ameet Dravid
- Department of Medicine, Poona Hospital and Research Centre, Maharashtra, India
- * Correspondence: Ameet Dravid, Poona Hospital and Research Centre, Sadashiv Peth, Pune, Maharashtra 411030, India (e-mail: )
| | - Anant S. Pilawan
- Department of Medicine, Government Medical College and Hospital, Maharashtra, India
| | - Anuradha S.
- Department of Medicine, Maulana Azad Medical College, New Delhi, India
| | | | - John T Ramapuram
- Department of Internal Medicine, Kasturba Medical College, Karnataka, India
| | | | - K. Sunil Naik
- Department of Medicine, Rajiv Gandhi Institute of Medical Science and RIMS Government General Hospital, Andhra Pradesh, India
| | - Milind Bhrusundi
- Department of Medicine, NKP Salve Institute of Medical Sciences and Late Mangeshkar Hospital, Maharashtra, India
| | - Raveendra K. R
- Department of Internal Medicine, Bangalore Medical College and Research Institute, Karnataka, India
| | | | - Vinay Kulkarni
- Department of Dermatology, Deenanath Mangeshkar Hospital & Research Centre, Maharashtra, India
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Dravid A, Morkar D, Prasad D, Ramapuram JT, Patel KV, Naik KS, Bhrusundi M, Kulkarni M, Hegde S, Anuradha S, Nageswaramma S, Madan S, Jayaprakash T, Kulkarni V. A Phase IV Study on Safety, Tolerability and Efficacy of Dolutegravir, Lamivudine, and Tenofovir Disoproxil Fumarate in Treatment Naïve Adult Indian Patients Living with HIV-1. Pragmat Obs Res 2022; 13:75-84. [PMID: 35975180 PMCID: PMC9375976 DOI: 10.2147/por.s361907] [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] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/23/2022] [Accepted: 07/25/2022] [Indexed: 11/23/2022] Open
Abstract
Purpose WHO recommends dolutegravir (DTG) based regimens as first-line treatment for HIV-1 infection. However, few studies have been conducted in Indian population. Hence, our study evaluated the safety, tolerability, and efficacy of DTG 50 mg with Tenofovir and Lamivudine (300/300mg) fixed dose combination in treatment naïve adult Indian patients. Methods This was an open label, multicenter, prospective, interventional, phase IV study conducted across 14 sites between February 2019 and July 2020. 24 weeks was the treatment duration for each subject. The primary end point was to assess the incidence of adverse events (AEs) and secondary end points were to assess the proportion of patients achieving plasma HIV-1 RNA levels <50 copies/mL at week 24 and change in CD4+ cell count from the baseline. Safety analysis was conducted using Safety Analysis Set and efficacy analysis was carried out using Full Analysis Set and Per protocol set. Results A total of 288 patients were screened; 250 were enrolled; and 229 completed the study. 389 AEs were reported from 58% of patients. Of these, 61 were related to study treatment. One event of decreased creatinine clearance led to study discontinuation. One serious event of pyrexia was reported, which was unrelated to the study drug. The most common AEs were headache (18%), pyrexia (14%), vomiting (6.4%) and upper respiratory tract infections (6%). No deaths were reported. At week 24, 86.8% of the patients achieved plasma HIV-1 RNA levels <50 copies/mL and the mean CD4 cell count increased from 350.2 (SD, 239.73) at baseline to 494.6 (SD, 261.40) with an average increase of 143.2 (SD, 226.14) cells. Conclusion This study demonstrated the safety and efficacy of DTG based regimen in treatment naïve HIV-1 patients in Indian population and support use of DTG as first-line treatment regimen.
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Affiliation(s)
- Ameet Dravid
- Department of Infectious Diseases and Clinical Research, Poona Hospital and Research Centre, Pune, Maharashtra, India
| | - Dnyanesh Morkar
- Department of Medicine, KLE's Dr Prabhakar Kore Hospital and MRC, Belagavi, Karnataka, India
| | - Dwijendra Prasad
- Department of General Medicine, People Tree Hospital 2, Bangalore, Karnataka, India
| | - John T Ramapuram
- Department of Medicine, Kasturba Medical College Hospital, Mangalore, Karnataka, India
| | | | - K Sunil Naik
- Department of General Medicine, Rajiv Gandhi Institute of Medical Sciences and RIMS Government General Hospital, Srikakulam, Andhra Pradesh, India
| | - Milind Bhrusundi
- Department of Medicine, Lata Mangeshkar Multi Specialty Hospital, Nagpur, Maharashtra, India
| | - Milind Kulkarni
- Department of Medicine, Sahyadri Super Specialty Hospital, Pune, Maharashtra, India
| | - Sanjeev Hegde
- Department of Global Clinical Operations, Viatris, Bengaluru, Karnataka, India
| | - S Anuradha
- Department of Medicine, Maulana Azad Medical College and Associated Lok Nayak, New Delhi, India
| | | | - Surabhi Madan
- Department of Clinical Research, Care Institute of Medical Sciences (CIMS) Hospital, Ahmedabad, Gujarat, India
| | | | - Vinay Kulkarni
- Department of Dermatology, LMMF's Deenanath Mangeshkar Hospital and Research Center, Pune, Maharashtra, India
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