Adverse events of raltegravir and dolutegravir


In the prospective Swiss HIV Cohort study all treatment naïve patients who initiated antiretroviral therapy with raltegravir or dolutegravir between 2006 and 2015 were evaluated for treatment modifications during the first year of treatment. 2,091 patients started raltegravir and 1,950 dolutegravir. Virological failure was extremely rare, 0.5 % for raltegravir and 0.01 % for dolutegravir. The total discontinuation rate was 15.5 per 100 patient years. The main reason for discontinuation was convenience expressed as patient´s wish, physician´s decision or treatment simplification. The most common reported toxic adverse reaction was neuropsychiatric complaints which were more common with dolutegravir, 1.7 % compared to 0.6 % for raltegravir. The difference was statistically significant (p=0.037)

Elziet al. AIDS 2017;31:1853-1858

Comment: Neuropsychiatric adverse events with dolutegravir were rare in randomized clinical registration trials. However, cohort studies have reported much higher than expected neuropsychiatric adverse events. The high rate is not confirmed
in the present large Swiss cohort study. The total rate of neuropsychiatric adverse events is low with dolutegravir even though it is even lower with raltegravir.