Initial highly-active antiretroviral therapy with a protease inhibitor versus a non-nucleoside reverse transcriptase inhibitor: discrepancies between direct and indirect meta-analyses Chou R, Fu R, Hoyt Huffman L, Korthuis PT The Lancet. Vol. 368, Issue 9546, 28 October 2006, Pages 1503-1515


New Study Shows More Convenient HIV Treatment As Effective As More Complex Regimens Medical News Today 28 Oct 2006




This study turns on the comparison of outcomes of treatment with initial highly-active antiretroviral therapy (HAART) with a protease inhibitor (PI) versus a non-nucleoside reverse transcriptase inhibitor (NNRTI).

While multiple factors play a role in these therapies, the pertinent point for our purposes is the regimen simplification now possible for some HIV treatments. Although protease inhibitors have typically required multiple doses each day, efavirenz, a NNRTI, can be taken in one daily dose. Efavirenz has been combined with emtricitabine and tenofovir, two nucleoside reverse transcriptase inhibitors, to produce the first FDA approved one dose each day medication to treat HIV. AHRQ Director Carolyn M. Clancy, M.D. describes the potential importance of this new version

Study Parameters

The study involved a meta-analysis of 12 trials of at least 24 weeks directly comparing NNRTI-based versus PI-based HAART in HIV-infected patients with limited or no previous exposure to antiretrovirals, six trials of NNRTI-based HAART, and eight trials of PI-based HAART, each versus two NRTI regimens. Outcomes were analyzed with regard to virological suppression, death or disease progression, and withdrawals due to adverse events.

Results

According to the article’s summary:
In the direct meta-analysis, NNRTI-based regimens were better than PI-based regimens for virological suppression …. The difference was reduced in higher-quality trials, but still favoured NNRTI-based HAART. There were no differences in death or disease progressio n… or withdrawal because of adverse events. … There were no significant differences for death or disease progression … [or for] withdrawals because of adverse events.

Commentary

That disease progression was found to be similar for both regimens and virological suppression was more effective when NNRTI-based treatment was used sets the stage for a test of the hypothesis that regimen simplification improves compliance and outcomes. While this is especially significant in the management of HIV disorders, the results could also provide important information re adherence to other treatment regimens.

• Fixed-Dose Combinations Improve Medication Compliance: A Meta-Analysis
• Meta-Analysis Disputes Assumptions About Nonadherence With HIV Treatment
• Another Medication Dose Packaging Plan Promoted
• Individualized Dose Packets Simplify Medication Adherence
• Judging Competency To Comply With Or Refuse Treatment