Session: 262. HIV: Antiretroviral Therapy, Saturday, 12:15-1:30 p.m.
Three-drug regimens (3DRs) have long been the mainstay of antiretroviral treatment (ART) for HIV. Dolutegravir-based two-drug regimens (DTG 2DRs) are now accepted alternatives to 3DRs, with the first 2DR single tablet regimen (STR), Juluca (DTG/rilpivirine [RPV]), FDA-approved in 2017. This study evaluated treatment patterns of DTG+RPV in clinical practice to understand use prior to availability of DTG/RPV STR.
A retrospective medical chart review was conducted across 10 US sites identified as using any DTG 2DRs. Eligible patients were adults initiated on DTG 2DR prior to 31/Jul/2017 and followed up to 30/Jan/2018. This analysis describes a subgroup who received DTG+RPV 2DR. Patient demographics, clinical characteristics and treatment history were abstracted from medical charts. Analyses were descriptive.
From an overall sample of 278 DTG 2DR patients, 66 received DTG+RPV 2DR. In this DTG+RPV subgroup, mean age was 56 years, 79% were male and 68% were Caucasian. Most were treatment-experienced (97%), with an average 15.5 years of prior ART; 48% had received ≥ 4 prior regimens. The most common physician reported reasons for initiating DTG+RPV were avoidance of potential long-term toxicities (53%), toxicity/intolerance of ARVs (20%) and treatment simplification/streamlining (15%). Prior to initiation of DTG+RPV, 70% of patients were virologically suppressed (< 50 copies/ml); of those, 98% remained suppressed after switching to DTG+RPV. Of the 30% of patients with detectable viral load prior to DTG+RPV initiation, 60% achieved and maintained virologic suppression on DTG+RPV. Mean time on DTG+RPV was 1.6 years. Only 5 (8%) patients discontinued DTG+RPV by data cut-off, and one patient was lost to follow-up. Reasons for discontinuation were virologic failure (n=2), treatment simplification/streamlining (n=2) and toxicity/intolerance (n=1). Physicians reported that most patients (91%) achieved the desired outcome from DTG+RPV use.
Prior to commercial availability of DTG/RPV STR in the US, DTG+RPV was used primarily in treatment experienced patients, most commonly to avoid potential long-term toxicities. A high proportion of patients achieved the desired outcome and maintained virologic suppression while receiving DTG+RPV.
Douglas Ward– Physician, Dupont Circle Physicians Group, Washington, DC
Steven Scheibel– Director of Research, Borrego Health, Cathedral City, CA
Moti Ramgopal– Medical Director, Midway Research Center, Ft. Pierce, FL
David Riedel– Associate Professor, Institute of Human Virology, University of Maryland School of Medicine, Baltimore, MD
Cindy Garris– Director, ViiV Healthcare, Raleigh, NC
Alan Oglesby– Sr. Director, ViiV Healthcare, Research Triangle Park, NC
John Waller– Associate Director, Adelphi Real World, Bollington, England, United Kingdom
Jenna Roberts– Director, Adelphi Real World, Macclesfield, England, United Kingdom
Katie Mycock– Associate Manager, Observational Research, Adelphi Real World, Bollington, England, United Kingdom
Shelly Dhir– Medical Director, ViiV Healthcare, Raleigh, NC
Collins Bonnie– Medical Science Liaison, ViiV Healthcare, Laurel, MD
Dominguez Megan– Medical Science Liaison, ViiV Healthcare, Arlington, MA
Joseph Mrus– Executive Medical Director, ViiV Healthcare, Cary, NC
James Pike– Senior Statistical Scientist, Adelphi Real World, Bollington, England, United Kingdom