Raltegravir once daily


In an earlier study of raltegravir, 800 mg once daily was compared to the standard dose of twice daily raltegravir given together with tenofovir disoproxil fumarate and emtricitbine (TDF/FTC). The once daily regimen was inferior to twice daily and the study was interrupted prematurely. In a new 2:1 randomized study, 1200 mg once daily raltegravir was compared to 400 mg twice daily given to treatment naïve HIV-positive individuals with HIV-RNA > 1,000 copies/mL (n=797). In both study arms raltegravir was combined with TDF/FTC. The primary endpoint was HIV-RNA less than 40 copies/mL after 48 weeks. After 48 weeks, 89 % of once daily recipients and 88 % of twice daily recipients had viral load less than 40. Raltegravir 1200 mg given once daily was thus non-inferior to the standard dose of 400 mg twice daily. Side effects were not significantly different between the two study arms.

Cahn et al. Lancet HIV 2017;Published online September 11, 2017 http://dx.doi. org/10.1016/S2352-3018(17)30128-5

Comment: By increasing the dose to 1200 mg from 800 mg, raltegravir can be used for once daily therapy. This is of course a welcome improvement as most patients definitely prefer once daily regimens. The competition with other once daily existing and developing integrase inhibitors is however tough and it remains to be seen to what extent this improvement will affect the use of raltegravir.