P209\u2005Switching to Doravirine in cart experienced patients: effective, highly tolerated, and cost saving. A retrospective cohort study

Abstract

Background Doravirine is a NNRTI with demonstrated effect as third agent in treatment naive and experienced HIV patients. Aim To evaluate outcomes of cART experienced patients switching their therapy to DOR/TDF/3TC or doravirine based regimens, with focus on efficacy, tolerability and costs. Methods Baseline characteristics like treatment history, and laboratory values were retrospectively collected with follow up data at 6 months. If patients stopped therapy, reasons were evaluated. Baseline and follow-up data were compared in patients that continued therapy using IBM SPSS. Potential cost savings compared to prior cART were estimated for the cohort that continued DOR/TDF/3TC for follow-up period and extrapolated to the average per year. Results A total of 377 patients (91% men) were included that completed outpatient clinic visit or/and laboratory data at 6 months: 97.1% switched to Doravirine/tenofovir/lamivudine (DOR/TDF/3TC) and 2.9% to other doravirine based regimens. Doravirine was prematurely stopped in 58/377 patients (15.4%). Reason to stop was a patient-reported adverse event in 43/377 patients (11.4%); most frequently gastrointestinal (3.8%) or insomnia/sleep disturbances (3.4%). Other reasons were virologic failure (0,8%) with only 1 case demonstrating resistance (V106VA, V108VI), decreased renal function (0,8%), and ALAT grade 2 (0,5%). Within the group that continued doravirine grade 1 ALAT elevation was more frequently observed at 6 months compared to baseline (14.2% vs. 7.9% (p=0.004), n=318); no grade 2/3/4 increase was observed. A decrease in LDL-c was seen (3.50 (±1.10) mmol/L vs. 2.97 (±0.79) mmol/L; n=42, p Conclusion Doravirine is a suitable therapy for maintenance treatment and shows enormous savings. In addition, our data shows that it is also effective and well tolerated by 85% in our patient group.