Assessment of Gastrointestinal Adverse Effects during the First Six Months of "Biktarvy" Antiretroviral Therapy: Age-Related Patterns and Their Relation with Changes of 5 kg Weight Loss/Gain in the Initial Treatment Period

BACKGROUND

The battle against HIV has led to the development of antiretroviral therapy (ART), including BIKTARVY®, which combines three potent agents. However, concerns about gastrointestinal side effects during the early phases of treatment have emerged, potentially impacting patient adherence and outcomes.

MATERIALS AND METHODS

This retrospective cohort study, conducted over four years in Romania, examined 222 patients initiated on BIKTARVY® therapy. Data were collected from electronic medical records, and stringent inclusion and exclusion criteria were applied to ensure data accuracy and relevance. Statistical analysis was performed to assess age-related patterns in gastrointestinal symptoms and their relation with significant weight loss.

RESULTS

This study revealed significant differences in the prevalence of gastrointestinal symptoms between age groups, with older patients experiencing more symptoms. Notably, diarrhea did not exhibit a statistically significant age-related difference. Furthermore, weight loss exceeding 5 kg was more common in older patients. Of the patients who continued BIKTARVY® therapy, 84.9% showed an increase in CD4 cell counts, and most expressed satisfaction with treatment.

CONCLUSION

Understanding age-related patterns and gastrointestinal side effects of BIKTARVY® is crucial for optimizing HIV patient care. Future research should aim to corroborate and expand upon these findings, potentially leading to improved therapeutic approaches in the ongoing fight against HIV.

Corrigendum: GLP-1RAs caused gastrointestinal adverse reactions of drug withdrawal: a system review and network meta-analysis

[This corrects the article DOI: 10.3389/fendo.2023.1149328.].

GLP-1RAs caused gastrointestinal adverse reactions of drug withdrawal: a system review and network meta-analysis

Background

Glucagon-like peptide-1 receptor agonists (GLP-1RAs) significantly reduce postprandial blood glucose, inhibit appetite, and delay gastrointestinal emptying. However, it is controversial that some patients are intolerant to GLP-1RAs.

Methods

PubMed, Embase, Web of Science, and Cochrane Library were searched for randomized controlled trials (RCTs) using GLP-1RAs with documented withdrawal due to gastrointestinal adverse reactions (GI AEs) from their inception to September 28, 2022. After extracting the information incorporated into the studies, a random-effects network meta-analysis was performed within a frequentist framework.

Results

64 RCTs were finally enrolled, which included six major categories of the GLP-1RA. The sample size of the GLP-1RAs treatment group was 16,783 cases. The risk of intolerable gastrointestinal adverse reactions of Liraglutide and Semaglutide was higher than that of Dulaglutide. Meanwhile, the higher the dose of the same GLP-1RA preparation, the more likely to cause these adverse reactions. These intolerable GI AEs were not significantly related to drug homology or formulations and may be related to the degree of suppression of the appetite center.

Conclusion

Dulaglutide caused the lowest intolerable GI AEs, while Liraglutide and Semaglutide were the highest. For Semaglutide, the higher the dose, the more likely it is to drive GI AEs. Meanwhile, the risk of these GI AEs is independent of the different formulations of the drug. All these findings can effectively guide individualized treatment.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022359346, identifier CRD42022359346.

The risk factors for prolonged hemostatic clip retention after endoscopic submucosal dissection for gastric neoplasm

BACKGROUND

Endoscopic hemostatic clipping is a safe and efficient treatment used to manage bleeding or perforation during endoscopic submucosal dissection (ESD) for gastric neoplasm. However, the natural history of applied hemoclips during ESD has not been elucidated. As prolonged clip retention limits the use of magnetic resonance imaging and may impede the ulcer healing process, we investigated the factors associated with prolonged hemoclip retention during gastric ESD.

METHODS

We retrospectively reviewed 199 patients who underwent gastric ESD with hemoclip application from January 2006 to January 2019. The primary outcome was the prolonged hemoclip retention rate 3 months after ESD. We examined the records of subjects followed at 3, 6, and 12 months and then annually after ESD to monitor clip retention.

RESULTS

The prolonged hemoclip retention rate at 3 months was 27.1% (54/199). The risk of hemoclip retention was significantly lower at the antrum (19.6%, P = 0.03). Hemoclips at the angle tended to remain longer than other locations in the stomach (40.6%, P = 0.081) while there was no difference in the number of applied clips depending upon the location of the lesion. By Kaplan-Meier survival analysis, clips at the antrum detached significantly earlier than those at other locations (P = 0.011).

CONCLUSIONS

Most of the hemostatic clips attached during ESD were spontaneously removed by 3 months after gastric ESD. However, clips positioned at angle are suspected to have a high probability of prolonged retention. With this in mind, more attention is needed when using hemoclips on angle.

Does switching from oral to subcutaneous administration of methotrexate influence on patient reported gastro-intestinal adverse effects?

INTRODUCTION

When treating patients with methotrexate (MTX) the most frequently reported adverse effects (AE) are gastrointestinal (GI) with nausea being reported by 10-20%. If intolerable AE of oral MTX persist, switching from oral to subcutaneous (SC) or intramuscular (IM) administration is common. However, this approach is largely empirical and the evidence is inconsistent. To our knowledge, this will be the first study to estimate the change in GI AE of switching from oral to SC MTX.

METHODS

A retrospective postal survey was sent to patients who had changed from oral MTX to SC MTX. GI AE was rated by visual analogue scale (VAS) regarding frequency and intensity of nausea, frequency of vomiting and frequency of discomfort. All participants gave informed consent. No further ethical clearance was necessary according to national law.

RESULTS

Of the sample 39/57 (68.4%) responded. Significant reductions in VAS were found in three of four primary outcome measures for GI AE. Only frequency of vomiting was not significantly reduced.

CONCLUSION

Our findings support the common practice of switching from oral to SC MTX to alleviate GI AE, however, additional research is needed in order to clarify this rarely studied subject.