The DoDo experience: an alternative antiretroviral 2-drug regimen of doravirine and dolutegravir

Abstract

Background Currently available antiretroviral 2-drug regimen (2DR) fixed dose combinations may not be suitable for specific situations including the presence of resistance associated mutations (RAM) or drug − drug interactions (DDI). The data on the use of the non-nucleoside reverse transcriptase inhibitor doravirine (DOR) and the integrase inhibitor dolutegravir (DTG) as an alternative 2DR remain scarce. Methods People living with HIV with DOR + DTG as a 2DR are being followed in a prospective observational study. Results This analysis describes 85 participants with a median age of 57 years. Median CD4-nadir was 173/µl and a majority (66%) had a history of HIV-associated or AIDS-defining conditions. Antiretroviral history was mostly extensive, and documentation of RAM was frequent. The main reasons for choosing DOR + DTG were DDI (29%), tolerability (25%), and cardiovascular risk reduction (21%). Plasma viral load at switch was < 50 copies/ml in all but 3 instances, median CD4 count was 600/µl. DOR + DTG was later changed to another regimen in 10 participants after a median of 265 days, the other 75 participants have remained on DOR + DTG for a median of 947 days. Conclusion DOR + DTG as a 2DR proved to be a durable treatment option even in extensively pretreated individuals.

Durability of doravirine with dolutegravir dual regimen compared with other dolutegravir‐based dual combinations

“…In our analysis, viral undetectability was slightly higher. The largest cohort published so far was described in the single‐arm DoDo Study, which included 85 individuals with demographic and clinical features comparable to those of our DTG + DOR group [18]. The rate of virological suppression moved from 98.8% to 97.6%, whereas regimen discontinuation was registered in 12% of cases after 12 months of treatment.…”