Factors Associated With Weight Change After Continuing or Switching to a Doravirine-based Regimen

TL;DR

This study found that switching to a doravirine-based HIV treatment generally does not cause significant weight changes, though some groups may experience different effects.

Contribution

The study identifies demographic and prior regimen factors influencing weight changes when switching to doravirine-based HIV treatment.

Findings

Most participants had stable weight after switching to doravirine-based regimens.

Non-Black participants were more likely to experience weight loss or stable weight after switching.

Switching from non-nucleoside reverse transcriptase inhibitors was linked to more weight gain.

Abstract

Factors associated with weight change were examined in phase 3 studies in which adults living with HIV-1 continued or switched to doravirine-based antiretroviral regimens.

Participants were randomized to first-line therapy with doravirine or darunavir/ritonavir, each given with 2 nucleos(t)ide reverse transcriptase inhibitors (NRTIs) (DRIVE-FORWARD) and to doravirine/lamivudine/tenofovir disoproxil fumarate (TDF) or efavirenz/emtricitabine/TDF (DRIVE-AHEAD); after 96 weeks, participants continued (n = 466) or switched to (n = 423) doravirine for 96-week open-label extensions. In DRIVE-SHIFT, virologically suppressed participants on stable antiretroviral therapy were randomized to switch to doravirine/lamivudine/TDF at day 1 or week 24 through week 144 (n = 535). Generalized logistic models were used to analyze factors associated with weight loss (≥5% decrease), stable weight (<5% change), and weight gain (≥5% increase) after continuation or switch.

Most participants who continued or switched to doravirine also received TDF (>74%) and had stable weight (>57%). Weight loss (odds ratio [OR], 6.14) or stable weight (OR, 2.15) was more common in participants of non-Black versus Black heritage after switching to doravirine. More participants switching from weight-suppressive non-nucleoside reverse transcriptase inhibitors versus protease inhibitors experienced weight gain versus weight loss in DRIVE-SHIFT (OR, 0.41) and weight gain versus stable weight in DRIVE-FORWARD and DRIVE-AHEAD (OR, 0.60). No significant association between weight change and prior NRTI use was observed in DRIVE-SHIFT.

Overall, switching to doravirine was weight neutral, although weight change may differ by demographics and weight-suppressive properties of a prior regimen. More research in historically underrepresented groups may help explain these findings.

NCT02275780, NCT02403674, NCT02397096.

In three phase 3 clinical studies, switching to a doravirine-based regimen was weight neutral in most adults with HIV-1, although weight change differed across demographic subgroups and according to weight-suppressive properties of a prior regimen.

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