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Efficacy and safety of switching from branded to generic antiretrovirals in virologically suppressed HIV-infected patients.

Efficacy and safety of switching from branded to generic antiretrovirals in virologically suppressed HIV-infected patients.
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Gianotti N, Poli A, Galli L, Franzin M, Tadini P, Galizzi N, Carbone A, Merli M, Muccini C, Oltolini C, Andolina A, Spagnuolo V, Lazzarin A, Castagna A,


Gianotti N, Poli A, Galli L, Franzin M, Tadini P, Galizzi N, Carbone A, Merli M, Muccini C, Oltolini C, Andolina A, Spagnuolo V, Lazzarin A, Castagna A, (click to view)

Gianotti N, Poli A, Galli L, Franzin M, Tadini P, Galizzi N, Carbone A, Merli M, Muccini C, Oltolini C, Andolina A, Spagnuolo V, Lazzarin A, Castagna A,

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PloS one 2017 08 0112(8) e0182007 doi 10.1371/journal.pone.0182007

Abstract
BACKGROUND
Aim of this study was to evaluate the efficacy and the safety of switching from branded to generic antiretrovirals in patients with HIV-RNA <50 copies/mL. METHODS
Matched-cohort study of patients followed at a single clinical center. Since September 2014, all patients with HIV-RNA <50 copies/mL who were receiving branded lamivudine or zidovudine/lamivudine or efavirenz were switched to the generic compound (switchers) and matched, in a ratio 1:1, for age (±5 years), gender, anti-HCV antibodies, nadir and (±50 cells/μL) baseline CD4+ count (±100 cells/μL), duration of antiretroviral therapy (±1 year), with patients with HIV-RNA <50 copies/mL, on treatment with unavailable generic compounds (non-switchers). Incidence rates (IR) of different outcomes were calculated and compared by Poisson regression model. A confirmed HIV-RNA ≥50 copies/mL defined virological failure; any change in the antiretroviral regimen was defined as treatment discontinuation. RESULTS
Four hundred forty patients were switched to generic compounds (268 [61%] on lamivudine, 65 [15%] on zidovudine/lamivudine, 87 [20%] on efavirenz and 20 [4%] on efavirenz and either lamivudine or zidovudine/lamivudine). Over a median follow-up of 15.0 (12.1-15.7) months, virological failure occurred in four switchers (IR: 0.07 [0.02-0.18]/100-person months of follow-up [PMFU]) and in ten non-switchers (IR: 0.20 [0.10-0.35]/100-PMFU) (p = 0.0003), while treatment discontinuation occurred in 118 switchers (IR: 2.05 [1.70-2.44]/100-PMFU) and in 128 non-switchers (IR: 2.37 [1.99-2.81]/100-PMFU) (p = 0.699).

CONCLUSIONS
After more than one year of follow-up, we found no evidence of increased risk of reduced efficacy or increased toxicity after switching from branded to generic lamivudine or zidovudine/lamivudine or efavirenz.

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