Clinical use, efficacy, and durability of maraviroc for antiretroviral therapy in routine care: A European survey

Objectives The study aimed to survey maraviroc use and assess effectiveness and durability of maraviroc-containing antiretroviral treatment (ART) in routine practice across Europe. Methods Data were retrieved from 26 cohorts in 8 countries comprising adults who started maraviroc in 2005-2016 and had >= 1 follow-up visit. Available V3 sequences were re-analysed centrally for tropism determination by geno2pheno[coreceptor]. Treatment failure (TF) was defined as either virological failure (viral load > 50 copies/mL) or maraviroc discontinuation for any reason over 48 weeks. Predictors of TF were explored by logistic regression analysis. Time to maraviroc discontinuation was estimated by Kaplan-Meier survival analysis. Results At maraviroc initiation (baseline), among 1,381 patients, 67.1% had experienced >= 3 ART classes and 45.6% had a viral load < 50 copies/mL. Maraviroc was occasionally added to the existing regimen as a single agent (7.3%) but it was more commonly introduced alongside other new agents, and was often (70.4%) used with protease inhibitors. Accompanying drugs comprised 1 (40.2%), 2 (48.6%) or.3 (11.2%) ART classes. Among 1,273 patients with available tropism data, 17.6% showed non-R5 virus. Non-standard maraviroc use also comprised reported once daily dosing (20.0%) and a total daily dose of 150mg (12.1%). Over 48 weeks, 41.4% of patients met the definition of TF, although the 1-year estimated retention on maraviroc was 82.1% (95% confidence interval 79.9-84.2). Among 1,010 subjects on maraviroc at week 48, the viral load was > 50 copies/mL in 19.9% and > 200 copies/mL in 10.7%. Independent predictors of TF comprised a low nadir CD4 count, a detectable baseline viral load, previous PI experience, non-R5 tropism, having >= 3 active drugs in the accompanying regimen, and a more recent calendar year of maraviroc initiation. Conclusions This study reports on the largest observation cohort of patients who started maraviroc across 8 European countries. In t