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Joe MB, Roland L, Laurent C, Patrick LM, Sawoo O, Gaston TL, Bruno E, Gilles P, Philippe P. Concomitant Use of Cotrimoxazole and Atazanavir in HIV-infected Patients: A Therapeutic Drug Monitoring and Pharmacovigilance Based Dual Approach. ACTA ACUST UNITED AC 2020; 14:214-223. [PMID: 30961507 DOI: 10.2174/1574884714666190405160612] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2019] [Revised: 03/25/2019] [Accepted: 03/26/2019] [Indexed: 01/12/2023]
Abstract
BACKGROUND Cotrimoxazole is the main antibiotic used in primary prophylaxis for opportunistic infections in advanced HIV infection. This drug can inhibit one of the metabolic pathways of atazanavir (ATV), such as the cytochromes P450 (CYP) 2C8/2C9 and could interfere with its safety and efficacy. OBJECTIVE We studied the drug-drug interaction (DDI) between cotrimoxazole and ATV by using therapeutic drug monitoring (TDM) and pharmacovigilance (PV) approaches. METHODS We compared a group of patients treated with cotrimoxazole and receiving an ATV-based regimen to controls. This historical cohort analysis used data from Dat'AIDS in HIV-infected patients who had at least two lowest plasma concentrations (C-trough) of ATV during their outpatient follow-up. Likewise, we used the international pharmacovigilance data from VigiBase to evaluate the notifications of hyperbilirubinemia reported with ATV. RESULTS In the TDM analysis, the two groups of patients (treated with cotrimoxazole and controls) were almost homogeneous concerning the main baseline features. After at least six months of ATVbased regimen, there was no significant difference in the safety threshold of the ATV C-trough [with an adjusted odds ratio (aOR) of 1.4 (95% CI: 0.5 - 4.4)] compared to controls. We observed similar results with the efficacy thresholds of ATV C-trough. Regarding the PV analysis, there was no difference in hyperbilirubinemia occurring with ATV when cotrimoxazole was concomitant, with an adjusted reporting odds ratio (aROR) of 0.9 (95% CI: 0.6 to 1.2). CONCLUSION This study showed a relevant concomitant use between Cotrimoxazole and ATV based on TDM and PV approaches.
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Affiliation(s)
- Miantezila B Joe
- EA4065 Ecosystème Intestinal, Probiotique, Antibiotiques, Université Paris Descartes SPC, Paris, France.,Unité de Pharmacologie Clinique, Université de Kinshasa, Kinshasa, RD, Congo.,Centre Régional de Pharmacovigilance, Hôpital Cochin, Assistance publique- Hopitaux de Paris, Paris, France
| | - Landman Roland
- Service des Maladies Infectieuses et Tropicales, Hôpital Bichat, Paris, France.,IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France
| | - Chouchana Laurent
- Centre Régional de Pharmacovigilance, Hôpital Cochin, Assistance publique- Hopitaux de Paris, Paris, France.,EA7323 Evaluation thérapeutique et pharmacologie périnatale et pédiatrique, Université Paris Descartes, Sorbonne Paris Cité, Paris, France
| | - Lê M Patrick
- IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France.,AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie, Paris, France
| | - Olivier Sawoo
- EA4065 Ecosystème Intestinal, Probiotique, Antibiotiques, Université Paris Descartes SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, Paris, France
| | - Tona L Gaston
- Unité de Pharmacologie Clinique, Université de Kinshasa, Kinshasa, RD, Congo
| | - Eto Bruno
- TBC TransCell-Lab, Faculté de Médecine Xavier Bichat, Paris, France
| | - Peytavin Gilles
- IAME, UMR 1137, Université Paris Diderot, Sorbonne Paris Cité and INSERM, Paris, France.,AP-HP, Hôpital Bichat-Claude Bernard, Laboratoire de Pharmaco-Toxicologie, Paris, France
| | - Pochart Philippe
- EA4065 Ecosystème Intestinal, Probiotique, Antibiotiques, Université Paris Descartes SPC, Paris, France.,Microbial Ecology Laboratory (MIEL), CNAM, Paris, France
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