RESUMEN
Switching from oral antiretroviral treatment to intramuscular (IM) cabotegravir (CAB) + rilpivirine (RPV) has an optional oral lead-in to ensure tolerability. The British HIV Association guidelines advise against directly switching from oral antiretroviral (ART) combinations containing strong/moderate cytochrome inducers like efavirenz (EFV) to IM CAB + RPV. EFV has a prolonged elimination half-life, leading to a residual induction of UGT1A1 and CYP3A4 after discontinuation. These enzymes are responsible for CAB and RPV metabolism and their induction might lead to sub-optimal concentrations of CAB and RPV, risking drug resistance. When switching from EFV to oral CAB + RPV, the ATLAS and ATLAS 2M studies showed reduced RPV concentrations but with maintained viral suppression during the oral lead-in and subsequent long-acting injectable (LAI) phases. Also, a recent pharmacokinetic modelling study indicated reduced RPV concentrations, without viral implication, when switching from EFV to IM CAB + RPV. However, there are limited real-world data on direct switching from EFV-based therapy to long-acting IM CAB + RPV. We describe a case where oral intake was impossible in a critical care scenario, switching from emitricitabine/tenofovir-DF (FTC/TDF) 200/245 mg + 600 mg EFV to IM CAB + RPV for treatment optimisation.
Asunto(s)
Antirretrovirales , Benzoxazinas , Ciclopropanos , Dicetopiperazinas , Piridonas , Rilpivirina , Humanos , Rilpivirina/uso terapéutico , Alquinos , TenofovirRESUMEN
One of the major symptoms of schizophrenia is cognitive deficits. Despite this, these impairments still lack an effective treatment. It was hoped that atypical antipsychotics would treat these symptoms better than their first generation counterparts, but unfortunately the likes of quetiapine and clozapine did not do so. Asenapine and lurasidone, two newer atypicals, have shown promise, as have agents that interact with the glutamate system. Another approach has been to add agents such as modafinil. More research is needed to consolidate the findings of these studies.
