(36) Efficacy of Bictegravir /Emtricitabine/Tenofovir Alafenamide (B/F/TAF) Versus Dolutegravir Combinations in HIV-1 Adult Population: A Systematic Review and Meta-Analysis

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 710

Presenting Author(s)

ANTO AMITH BIJU J, PharmD
– Ramaiah university of applied sciences, Department of pharmacy practice

Co-Author(s)

Aina M. Shaju, PharmD
– Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, Faculty of Pharmacy, M.S. Ramaiah University of Applied Sciences, Bangalore, Karnataka, India
Manoj Kumar Mudigubba
– Assistant Professor, Department of Pharmacy Practice, Faculty of Pharmacy, Ramaiah University of Applied Sciences, Bangalore, Karnataka, India

Background: Antiretroviral multiple regimens for the treatment of HIV-1 has the potential for drug interactions, medication resistance and non-adherence. To prevent these, combination treatment with three antiretroviral medicines as fixed dose single tablet aimed against at least two different molecular targets is promoted.

Objectives: To study the efficacy of Bictegravir /Emtricitabine/Tenofovir Alafenamide (B/F/TAF) versus Dolutegravir combinations in HIV-1 adult populations.

Methods: We systematically searched PubMed, EMBASE, and CENTRAL, as well as clinical registries (ClinicalTrials.gov, WHO), to identify RCTs comparing HIV-1 RNA taken after 48-week range in adult populations administered B/F/TAF versus dolutegravir combinations. Modified search strategy was built by using MesH terms. Study quality was assessed using the Cochrane Risk of Bias assessment tool. RCTs which include subjects with opportunistic infections, decompensated cirrhosis, chronic Hepatitis B Virus infection, and pregnant women were excluded from the review.
The primary outcome of interest was virologic suppression decline in HIV-1 RNA copies after administration of B/F/TAF and Dolutegravir combination. Studies were reviewed separately by three independent reviewers. Disagreements were settled via debate and consensus.
To organize the data and perform analyses using the standard Cochrane Collaboration approach, we utilized Review Manager 5.3. For dichotomous data, we estimated odds ratios (OR) using fixed- effect models and evaluated study heterogeneity visually by inspecting forest plots and statistically by using the Chi-square test.

Results: Out of the 71 records identified for title and abstract screening, 27 were shortlisted for full review, of which meta-analysis was performed on six RCTs (n=3133). A total of 1573 and 1574 participants were randomized to B/F/TAF and dolutegravir combinations, respectively. Two studies had “unclear” risk of bias. When data were pooled across trials, we detected no significant difference between Bictegravir and dolutegravir group in virological suppression with overall OR :0.93 (95 % CI {0.73–1.18}.

Conclusions: Our SRMA of RCTs suggests that, Bictegravir combination(B/F/TAF) is not different in efficacy when compared to Dolutegravir combinations. This supports the current clinical guideline from the WHO recommending B/F/TAF fixed dose combination for treating HIV-1 adults, considering the patients’ toxicity profile and non-availability of other preferred regimens