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Long Term Therapeutic Success of Etravirine in Switch and Naive Patients

Long Term Therapeutic Success of Etravirine in Switch and Naive Patients. L.Bull , M.Bower , M.Nelson Chelsea and Westminster Hospital, London. Background:. Etravirine is a second-generation  non-nucleoside  reverse transcriptase inhibitor (NNRTI) 

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Long Term Therapeutic Success of Etravirine in Switch and Naive Patients

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  1. Long Term Therapeutic Success of Etravirine in Switch and Naive Patients L.Bull, M.Bower, M.Nelson Chelsea and Westminster Hospital, London

  2. Background: • Etravirineis a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI)  • Effective in naïve and switch in those experiencing toxicity to efavirenz1.2 • Low toxicity • Once daily • Potential alternative to other first line third agents • Gazzardet al, AIDS, Nov2011. • Waters et al, AIDS, Jan 2011 2. Waters et al, AIDS, Jan 2011

  3. Methods: • Retrospective case review of all individuals receiving Etravirine with a two nucleos(t)ide backbone • August 2008 and December 2012

  4. Results N=389 345 VL<50 copies/ml 44 VL l>50 copies/m • Median CD4 505cells/mm3 Median CD4 count 300cells/mm3 • Range 137-1480 cells/mm3Range 31-701cells/mm3 • Median VL 44296 copies/ml • Range 508-1819837 copies/ml

  5. Switch Patients with an Undetectable Viral Load - Previous Third Agent N=345

  6. Reasons For Switch

  7. Reasons For Switch 12 from NRTIS: peripheral neuropathy, lipoatrophy ,nausea, transaminitis 7 from raltegravir : transaminitis, peripheral neuropathy, fatigue, poor sleep, depression 3 from nevirapine-nausea, depression, transaminitis 2 from rilpivirine: nausea 4 unknown

  8. Virological Control

  9. Virological Control: All patients with detectable viral loads were non compliant

  10. Reasons for Cessation of Etravirine 86 patients stopped Etravirine Toxicity 76 patients Drug Interactions 6 patients Virological failure 4 patients Chemotherapy 3 Hepatitis C Rx 3

  11. Mean Lipid Values Before and After Treatment with Etravirine

  12. Mean Lipid Values Before and After Treatment with Etravirine 4.93 4.54 P<0.0001* 4.68 4.42 P=0.002* 3.09 2.79 P=0.0001* 1.76 1.48 P<0.0001* 1.14 1.09 P=0.03*

  13. Switch with a Detectable Viral Load (>40 copies/ml) -Previous Third Agent, N=44 9 patients were naïve to therapy. Of the 35 others, median time on their previous regimen was 9 months (range 1 month to 9 years)

  14. Reasons Patients had VL>40 • 20 patients were restarting therapy after Rx break (compliance/ADR/toxicity) • 13 were switched from efavirenz with decreasing viral load with CNS side effects • 9 patients were ARV naïve • 2 patients switched from PI monotherapy with resistance

  15. Reasons for Switch

  16. Virological Control • 27/44 fully suppressed their viral load on etravirine • Remained suppressed for a median of 1 year (range three months to 3 years). • Median CD4 count at 6 months was 417cells/mm3 (range 340-493).

  17. Naïve Patients • All naïve patients suppressed their viral load within 6/12, 3 later stopped etravirine after a mean of 16 months due to: • Heartburn • X2 drug interactions (chemotherapy/hepatitis c) • The other 6 have remained undetectable for median of 2 years (range 6 months to 3 years)

  18. Reasons for Cessation of Etravirine 17 patients switched from etravirine All viraemic patients were non compliant with medication

  19. Virological Failure All patients non compliant, 4 develop ETR mutations

  20. Conclusions • Etravirine is an alternative switch option in individuals with an undetectable viral load and intolerant of their current third agent • Only one individual switching with an undetectable viral load developed resistance to ETR over a total follow up of 803 patients years • Switching to etravirine resulted in improvements in total cholesterol, LDL and TGs • Limited data available in individuals naïve to therapy and further data is required

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