Da Sustiva (efavirenz) a Intelence (etravirine)

Un nuovo studio dimostra che cambiando farmaco da Sustiva a Intelence (etravirine), non si hanno piu' effetti collaterali a livello celebrale.

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Switching Anti-HIV Therapy From Sustiva To Intelence May Help Reduce Neurological Side Effects
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By Meerat Oza and Courtney McQueen
Published: Jan 14, 2011 4:24 pm

Using Intelence instead of Sustiva may help reduce some of the neurological side effects associated with Sustiva, such as insomnia, abnormal dreams, and nervousness, according to a small recent study.

However, switching did not affect other neurological symptoms, such as depression, impaired concentration, or headaches.

Sustiva (efavirenz) is associated with a number of side effects, the most common of which are psychiatric, neurological, or skin-related. Neurological side effects refer to the central nervous system and include symptoms such as dizziness, depression, insomnia, anxiety, impaired concentration, headaches, somnolence (sleepiness), fatigue, abnormal dreams, nervousness, and hallucinations.

Approximately 19 percent of patients experience neurological side effects when using Sustiva. Most side effects will usually resolve on their own within two to four weeks; however, some patients experience long-term side effects. As a result, neurological symptoms are a common reason patients discontinue Sustiva or switch treatment.

Intelence (etravirine), which is an antiretroviral in the same drug class as Sustiva, is associated with fewer neurological side effects.

In this study researchers studied whether switching from Sustiva to Intelence could successfully reduce or eliminate side effects without reducing the effectiveness of antiretroviral therapy.

A total of 38 men taking Sustiva who reported long-term side effects participated in the study. The first group of 20 patients was randomly assigned to switch immediately from Sustiva to Intelence. The remaining study participants continued Sustiva treatment. The researchers did not tell the participants whether they were in the group that switched treatment.

After 12 weeks, the researchers switched all participants to Intelence and informed them about the switch. They monitored the patients for an additional 12 weeks.

Throughout the entire study period, the researchers monitored neurological side effects in the study participants.

At the beginning of the study, both groups had similar occurrences of neurological side effects. In the group treated with Intelence, 90 percent of patients experienced side effects, compared to 89 percent of patients in the group treated with Sustiva.

However, by week 12 of the study, the number of people experiencing a neurological side effect had fallen to 60 percent in the group treated with Intelence. Those treated with Sustiva retained the same level of side effects.

After 24 weeks, results were similar. There were no further reductions in side effects in the group that had switched to Intelence early. In the group that switched later, fewer side effects were reported but the difference was not considered significant. The exception was the number of abnormal dreams reported, which had declined by 24 weeks in the group that switched later.

An overall analysis of the study participants over 24 weeks showed that switching from Sustiva to Intelence led to fewer reports of nervousness, insomnia, and abnormal dreams.

The switch from Sustiva to Intelence had no effect on the other side effects studied. The researchers speculated that these other symptoms may be partly due to other factors.

All of the study participants successfully maintained viral suppression (undetectable amount of HIV in the blood) throughout the study, indicating that switching did not affect the efficacy of their antiretroviral regimens.

For more information, please see the study in AIDS (abstract).