Evaluating the appropriateness of dosing adjustments in the coadministration of maraviroc and CYP3A inhibitors: A literature review

James Samuel Alcorn

eISSN: 1732-2707
ISSN: 1730-1270

HIV & AIDS Review. International Journal of HIV-Related Problems

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3/2016
vol. 15

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abstract:

Review paper

Evaluating the appropriateness of dosing adjustments in the coadministration of maraviroc and CYP3A inhibitors: A literature review

James Samuel Alcorn

HIV & AIDS Review 15 (2016) 122–126

Online publish date: 2016/11/15

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Aim: To elucidate the appropriateness of once-daily dosing of maraviroc when administered concomitantly with a CYP3A inhibitor, a deviation from the labeled dosing in the United States.

Background: Practitioners have been known to prescribe doses of 300 mg once daily without clear evidence to improve compliance, primarily in patients with medication adherence issues.

Materials and Methods: A review of published literature related to maraviroc pharmacokinetics and pharmacodynamics was performed and data from existing studies is presented and critically evaluated.

Results: The findings with regards to extended dosing intervals of maraviroc in the agent’s pivotal studies are discordant. While the MOTIVATE trials have suggested that the use of MVC once daily is more effective than placebo at reducing HIV-1 RNA levels as well as improving CD4 cell count, the data suggesting this efficacy was determined in studies that had significant limitations, the most important of these limitations being the fact that all patients in the MOTIVATE trials were controlled on optimized background therapy consisting of three to six active antiretroviral agents. MERIT shows that once daily dosing is inadequate due to a lack of viral load suppression.

Conclusion: The use of an extended (once-daily) dosing interval is not supported by current data and such an adjustment may lead to poor viral suppression and potential treatment failure.

keywords:

Maraviroc, CCR5 antagonism, Extended interval