Incidence and Severity of Drug Interactions Before and After Switching Antiretroviral Therapy to Bictegravir/Emtricitabine/Tenofovir Alafenamide in Treatment-Experienced Patients

Abstract

Background Switching antiretroviral therapy (ART) in people with HIV (PWH) can influence their risk for drug–drug interactions (DDIs). The purpose of this study was to assess changes in the incidence and severity of DDIs among PWH who switched their ART to bictegravir/emtricitabine/tenofovir alafenamide (BIC/FTC/TAF). Methods This was a multicenter retrospective cohort study of PWH on ART and at least 1 concomitant medication (CM) who switched to BIC/FTC/TAF between 3/2018 and 6/2019. Using the University of Liverpool’s HIV Drug Interaction Database, 2 DDI analyses were performed for each patient. The first assessed patients’ preswitch ART regimens with their CM list. The second assessed the same CM list with BIC/FTC/TAF. Each ART-CM combination was given a score of 0 (no or potential weak interaction), 1 (potential interaction), or 2 (contraindicated interaction). A paired t test analyzed changes in total DDI scores following ART switches, and linear regression examined factors contributing to DDI score reductions. Results Among 411 patients, 236 (57%) had at least 1 DDI present at baseline. On average, baseline DDI scores (SD) were 1.4 (1.8) and decreased by 1 point (95% CI, –1.1 to –0.8) after patients switched to BIC/FTC/TAF (P < .0001). After adjusting for demographics, baseline ART, and CM categories, switching to BIC/FTC/TAF led to significant DDI score reductions in patients receiving CMs for cardiovascular disease, neurologic/psychiatric disorders, chronic pain, inflammation, gastrointestinal/urologic conditions, and conditions requiring hormonal therapy. Conclusions Treatment-experienced PWH eligible to switch their ART may experience significant declines in number and severity of DDIs if switched to BIC/FTC/TAF.

Real-world efficacy of switching to bictegravir/ emtricitabine/tenofovir alafenamide in pretreated patients with triple therapy containing rilpivirine

“…Nuestro estudio tiene como importante limitación la naturaleza retrospectiva del análisis y el bajo número de pacientes incluido, pero ofrece datos del cambio desde RPV fundamental-mente para pacientes en los que se pretende evitar interacciones medicamentosas y con la alimentación. En las grandes series de cambio a B/F/TAF son pocos los pacientes que cambian a partir de un no análogo [ 8 - 10 ]. En el estudio en vida real de Rolle et al [ 11 ], sólo el 23% de 350 pacientes recibió B/F/TAF a partir de una pauta con 2 análogos y un no análogo sin especificar cual y en el estudio en fase 3 de Hagins et al [ 12 ] el cambio fue del 30%.…”

Real-world efficacy and safety of switching to bictegravir/emtricitabine/tenofovir alafenamide in older people living with HIV

“…[ 22 ] A significant reduction in DDI score (higher scores being indicative of more severe interactions) was also observed after switching to B/F/TAF in patients receiving concomitant medications for a variety of comorbidities including cardiovascular disease, neurological/psychiatric disorders, chronic pain, inflammation, gastrointestinal/urologic conditions, and conditions requiring hormonal therapy. [ 22 ] Many have warned about the complications associated with DDIs in older PLWH as comorbidities accumulate and have found that polypharmacy and DDIs are a source of increased morbidity and higher healthcare costs in this population. [ 23 – 26 ] A recent analysis of AEs due to inappropriate prescribing in older PLWH demonstrated that 30% of PLWH aged ≥65 years experienced ≥1 AE due to inappropriate prescribing, and the risk of having an AE increased as the total number of non-HIV medications increased (adjusted odds ratio 1.2, 95%CI: 1.1–1.3).…”

“…Other studies examining the impact of switching to B/F/TAF on DDIs have revealed similar findings. A multicenter, retrospective cohort study of 411 treatment-experienced PLWH on at least 1 concomitant medication reported a decrease in the number of total DDIs from 552 on the baseline regimen to 188 after switching to B/F/TAF [22] . A significant reduction in DDI score (higher scores being indicative of more severe interactions) was also observed after switching to B/F/TAF in patients receiving concomitant medications for a variety of comorbidities including cardiovascular disease, neurological/psychiatric disorders, chronic pain, inflammation, gastrointestinal/urologic conditions, and conditions requiring hormonal therapy [22] .…”

Optimizing the antiretroviral treatment focusing on long-term effectiveness and a person-centred approach. Consensus Guidance Using a Delphi Process

“…Moreover, the consensus was reached that HRQoL reported by PLWH is better in single tablet regimens (STR) than in multi-tablet regimens and that HRQoL monitoring over time assesses the experience of drug burden (number of tablets, food restrictions, ease of intake) and symptoms associated with treatment regimes. The complexity of the pharmacological burden, identifiable in the definition of polypharmacy, entails consequences for care, but also ethical, social and economic, while the concepts of deprescribing and therapeutic optimization might allow the reduction of potentially inappropriate drugs and drug-drug interactions, with the ultimate aim of improving the patient's quality of life [48][49][50][51]. The final statements are reported in Figure 4.…”