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Discontinuation due to neuropsychiatric adverse events with efavirenz- and dolutegravir-based antiretroviral therapy: a comparative real-life study
  1. Noelia Fernández-Bargiela1,
  2. Sandra Rotea-Salvo1,
  3. Luis Margusino-Framiñán1,2,
  4. Vanesa Balboa-Barreiro3,
  5. Isabel Martín-Herranz1,
  6. Ángeles Castro-Iglesias2,4,
  7. Álvaro Mena-De-Cea2,4,
  8. Soledad López-Calvo2,4,
  9. Pilar Vázquez-Rodríguez2,4,
  10. Enrique Míguez-Rey2,4,
  11. Purificación Cid-Silva1,2
  1. 1Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Spain
  2. 2Division of Clinical Virology, Biomedical Research Institute of A Coruña (INIBIC), University Hospital of A Coruña (CHUAC), SERGAS, Universitary of A Coruña, A Coruña, Spain
  3. 3Clinical Epidemiology and Biostatistics Unit, Biomedical Research Institute of A Coruña (INIBIC), Universitary Hospital of A Coruña (CHUAC), SERGAS, Universitary of A Coruña (UDC), A Coruña, Spain
  4. 4Service of Infectious Internal Medicine, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña, Spain
  1. Correspondence to Purificación Cid-Silva, Service of Pharmacy, Universitary Hospital of A Coruña (CHUAC), SERGAS, A Coruña 15006, Spain; purificacion.cid.silva{at}sergas.es

Abstract

Objectives Despite the high efficacy of antiretroviral treatment, no drug is free from adverse events (AEs). Efavirenz (EFV) and dolutegravir (DTG) are antiretroviral drugs for which neuropsychiatric adverse events (NPAEs) have been described. This study evaluated the safety and tolerability of DTG-based and EFV-based antiretroviral regimens in HIV-infected patients.

Methods A retrospective observational study was carried out in HIV-infected patients who started DTG- or EFV-based antiretroviral treatment from January 2008 to December 2018 at a reference hospital in north-western Spain. Epidemiological, clinical and immunovirological data were recorded. A statistical analysis was performed with SPSS software.

Results A total of 282 DTG- and 148 EFV-based therapies were initiated. During follow-up, statistically significant differences have been found between the rate of patients who discontinued DTG and EFV due to AEs (12.1% vs 35.8%, p<0.001) and the main AEs in both groups, NPAEs (8.2% vs 25.0%, p<0.001). Female gender (OR 2.610 (95% CI 1.327 to 5.133), p=0.005) was associated with discontinuations due to AEs. Patients with documented psychiatric disorders were at higher risk of discontinuation due to NPAEs (OR 4.782 (95% CI 1.190 to 19.220), p=0.027). The multivariate analysis showed a 61.2% risk reduction in benzodiazepine prescriptions in patients treated with DTG. In both groups, patients needed consultation and follow-up in the psychiatry unit (16.9% in the EFV group and 8.9% in the DTG group, p=0.021).

Conclusions We found a high rate of discontinuations due to AEs and NPAEs, prescription of benzodiazepines and a requirement for consultation in a psychiatric unit in both treatment groups, especially with EFV.

  • HIV & AIDS
  • clinical pharmacy
  • infectious diseases
  • side effects of drugs
  • adverse effects
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