Efficacy and safety of long-acting cabotegravir versus oral tenofovir disoproxil fumarate-emtricitabine as HIV pre-exposure prophylaxis: A systematic review and meta-analysis

by Selleckchem | Jun 26 2023

WHO guidelines recommend daily oral tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) for pre-exposure prophylaxis (PrEP) of HIV in people at high risk of HIV infection. However, due to social, psychological and other reasons, the compliance with daily oral TDF-FTC in real life is low. Long-acting cabotegravir is currently the only long-acting drug approved by the U.S. Food and Drug Administration (FDA) for HIV PrEP. Due to the long dosing interval (8 weeks), long-acting cabotegravir has low compliance requirements for people at high risk of HIV infection. We aimed to discuss the feasibility of long-acting cabotegravir to replace TDF-FTC as HIV PrEP based on efficacy and safety analyses. Randomized controlled trials were retrieved, and R software was used for meta-analysis after data extraction. and discussion: Results of the meta-analysis showed that compared with TDF-FTC, long-acting cabotegravir was associated with a lower risk of HIV infection (HR = 0.22, 95% CI: 0.08-0.59, p < 0.01), less decreased creatinine clearance (RR = 0.96, 95% CI: 0.93-0.99, p < 0.01), but more tolerated injection sites adverse events (p < 0.01). No statistically significant differences were found between long-acting cabotegravir and oral placebo in non-injection-related adverse events (creatine phosphokinase, headache, nasopharyngitis, upper respiratory tract infection and gastroenteritis) (p > 0.05). Long-acting cabotegravir has a manageable safety profile and is more effective than TDF-FTC in preventing HIV infection. Interestingly, decreased creatinine clearance occurred less frequently with long-acting cabotegravir than with TDF-FTC. Long-acting cabotegravir is very promising to replace TDF-TFC in the future, which requires more large-sample, high-quality RCTs to verify.

Comments:

Based on the information you provided, it appears that a meta-analysis was conducted to compare the efficacy and safety of long-acting cabotegravir with daily oral tenofovir disoproxil fumarate (TDF) and emtricitabine (FTC) for pre-exposure prophylaxis (PrEP) of HIV. Here are the key findings:

Effectiveness: The meta-analysis showed that long-acting cabotegravir was associated with a lower risk of HIV infection compared to TDF-FTC (HR = 0.22, 95% CI: 0.08-0.59, p < 0.01). This suggests that long-acting cabotegravir is more effective in preventing HIV transmission.

Renal function: The analysis found that long-acting cabotegravir was associated with less decreased creatinine clearance compared to TDF-FTC (RR = 0.96, 95% CI: 0.93-0.99, p < 0.01). This indicates that the long-acting formulation may have a lower impact on renal function.

Injection site adverse events: Long-acting cabotegravir was associated with more tolerated injection site adverse events compared to TDF-FTC (p < 0.01). These events are specific to the injection method and may include local reactions at the injection site.

Non-injection-related adverse events: No statistically significant differences were found between long-acting cabotegravir and oral placebo in non-injection-related adverse events such as creatine phosphokinase, headache, nasopharyngitis, upper respiratory tract infection, and gastroenteritis (p > 0.05). This suggests that the overall safety profile of long-acting cabotegravir is comparable to placebo in terms of non-injection-related adverse events.

Based on these findings, the study concludes that long-acting cabotegravir has a manageable safety profile and is more effective than TDF-FTC in preventing HIV infection. However, the authors note that more large-sample, high-quality randomized controlled trials (RCTs) are needed to further verify these results and assess the feasibility of replacing TDF-FTC with long-acting cabotegravir for HIV PrEP.

Please note that the information provided is based on the details you provided and should not replace professional medical advice. It's always recommended to consult with healthcare professionals or refer to official guidelines for specific medical decisions or treatment options.