Initial highly-active antiretroviral therapy with a protease inhibitor versus a non-nucleoside reverse transcriptase inhibitor: discrepancies between direct and indirect meta-analyses  

Oleh:

Chou, Roger ; Fu, Rongwei ; Huffman, Laurie Hoyt ; Korthuis, P. Todd

Jenis: Article from Journal - ilmiah internasional
Dalam koleksi: The Lancet (keterangan: ada di Proquest) vol. 368 no. 9546 (Oct. 2006), page 1503.

Ketersediaan

Perpustakaan FK Nomor Panggil: L01.K.2006.05 Non-tandon: 1 (dapat dipinjam: 0) Tandon: tidak ada

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Isi artikel

Background The optimum treatment choice between initial highly-active antiretroviral therapy (HAART) with a protease inhibitor (PI) versus a non-nucleoside reverse transcriptase inhibitor (NNRTI) is uncertain. An indirect analysis reported that PI-based HAART was better than NNRTI-based HAART. However, direct evidence for competing interventions is deemed more reliable than indirect evidence for making treatment decisions. We did a meta-analysis of head-to-head trials and compared the results with those of indirect analyses. Methods 12 trials of at least 24 weeks' duration directly compared NNRTI-based versus PI-based HAART in HIV-infected patients with limited or no previous exposure to antiretrovirals. We also identified six trials of NNRTI-based HAART and eight trials of PI-based HAART, each versus two NRTI regimens. We analysed the outcomes of virological suppression, death or disease progression, and withdrawals due to adverse events. Findings In the direct meta-analysis, NNRTI-based regimens were better than PI-based regimens for virological suppression (OR 1·60, 95% CI 1·31—1·96). The difference was reduced in higher-quality trials, but still favoured NNRTI-based HAART. There were no differences in death or disease progression (0·87, 0·56—1·35) or withdrawal because of adverse events (0·68, 0·43—1·08). By contrast, in indirect analyses NNRTI-based HAART was worse than PI-based HAART for virological suppression (0·26, 0·07—0·91). There were no significant differences for death or disease progression (1·28, 0·56—2·94) and withdrawals because of adverse events (1·46, 0·66—3·24). When trials of delavirdine were excluded, similar results were produced. Interpretation Results from direct analyses suggested that NNRTI-based HAART was more effective than PI-based HAART for virological suppression and was similar to PI-based HAART for clinical outcomes. Indirect comparisons could be unreliable for complex and rapidly evolving interventions such as HAART.

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