{"id":27476,"date":"2014-10-01T12:46:03","date_gmt":"2014-10-01T12:46:03","guid":{"rendered":"http:\/\/i-base.info\/htb\/?p=27476"},"modified":"2014-10-06T12:58:52","modified_gmt":"2014-10-06T12:58:52","slug":"switch-from-efavirenz-to-rilpivirine-quells-cns-toxicity-improves-sleep","status":"publish","type":"post","link":"https:\/\/i-base.info\/htb\/27476","title":{"rendered":"Switch from efavirenz to rilpivirine quells CNS toxicity, improves sleep"},"content":{"rendered":"

Mark Mascolini, NATAP.org<\/strong><\/p>\n

Switching from Atripla (efavirenz plus tenofovir\/emtricitabine [TDF\/FTC]) to Eviplera (rilpivirine plus TDF\/FTC) significantly relieved central nervous system (CNS) toxicity and improved sleep in people with those problems while taking Atripla.<\/strong><\/p>\n

All but 1 of 40 study participants who switched in this London\/Brighton study maintained virologic control through 24 weeks.<\/p>\n

The once-daily single-tablet combination pill Atripla remains a recommended and popular first-line antiretroviral regimen. People who start efavirenz in Atripla or other regimens often suffer short-term neurologic side effects, but sometimes those problems persist. Eviplera (Complera in the US) is a once-daily single-tablet combination of TDF\/FTC with another NNRTI, rilpivirine.<\/p>\n

UK researchers conducted this single-arm study to track changes in CNS toxicity and sleep patterns after people who had those problems with Atripla switched to Eviplera.<\/p>\n

To gauge changes in side effects, the investigators used the AIDS Clinical Trials Group CNS toxicity questionnaire, including 10 items such a dizziness, depression, anxiety, and somnolence. The sleep questionnaire included 19 items.<\/p>\n

The analysis included 40 people with Atripla-related CNS toxicity, 36 of them men. Age averaged 47 (range 24 to 73), and people had taken efavirenz for a median of 42 months (range 24 to 100).<\/p>\n

Median CD4 count at the switch measured 610 (interquartile range 436 to 884). \u2028\u2028One person had a detectable viral load at 60 copies 12 weeks after switching to Eviplera. After that, this person stopped keeping study visits. All other study participants maintained a viral load below 50 copies through 24 weeks.<\/p>\n

CD4 counts did not change substantially through 24 weeks of follow-up. \u2028\u2028Median total CNS score fell from 40 at the switch to Eviplera to 12 after 4 weeks, 20 after 12 weeks, and 13 after 24 weeks (p < 0.001 for all comparisons). Proportions of people reporting grade 2 to 4 adverse events improved significantly from baseline to week 24 for abnormal dreams, anxiety, confusion, depression, dizziness, insomnia, impaired concentration, and somnolence.<\/p>\n

Median total sleep questionnaire score improved from 30 at the switch to 14 at week 24 (p 0.001). Twenty-four weeks after the switch to Eviplera, study participants had significant improvements in total cholesterol (-0.9 mmol\/L), low-density lipoprotein cholesterol (-0.57 mmol\/L), and triglycerides (-0.35 mmol\/L) (p< 0.001 for all changes from baseline).<\/p>\n

A single serious adverse event, thrombocytopenia, emerged in 1 person.\u2028\u2028The researchers proposed that identifying people with efavirenz toxicity “is essential as use of alternate agents leads to improvement in tolerability and toxicity.”<\/p>\n

Reference<\/p>\n

Rowlands J et al. Multicenter open-label study of switching from Atripla to Eviplera for CNS toxicity. ICAAC 2014. September 5-9, 2014. Washington, DC. Abstract H-1005.
\nhttp:\/\/www.abstractsonline.com\/Plan\/ViewAbstract.aspx?sKey=d43f86d1-e2cd-4948-a76f-d621e985a233&cKey=980f5978-f9b0-439e-a8bb-95fc3d6e6b1a&mKey=5d6b1802-e453-486b-bcbb-b11d1182d8bb<\/a>
\nhttp:\/\/www.natap.org\/2014\/ICAAC\/ICAAC_55.htm<\/a><\/p>\n","protected":false},"excerpt":{"rendered":"

Mark Mascolini, NATAP.org Switching from Atripla (efavirenz plus tenofovir\/emtricitabine [TDF\/FTC]) to Eviplera (rilpivirine plus TDF\/FTC) significantly relieved central nervous system (CNS) toxicity and improved sleep in people with those problems while taking Atripla. All but 1 of 40 study participants …<\/p>\n","protected":false},"author":2,"featured_media":0,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[4,3],"tags":[195],"class_list":["post-27476","post","type-post","status-publish","format-standard","hentry","category-conference-reports","category-antiretrovirals","tag-icaac-54th-washington-2014"],"_links":{"self":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/27476","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/users\/2"}],"replies":[{"embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/comments?post=27476"}],"version-history":[{"count":0,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/posts\/27476\/revisions"}],"wp:attachment":[{"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/media?parent=27476"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/categories?post=27476"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/i-base.info\/htb\/wp-json\/wp\/v2\/tags?post=27476"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}