No Increased Risk of MI, CAD Seen With Abacavir Therapy
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SAN DIEGO—According to results of an expanded meta-analysis presented at IDWeek 2017, patients exposed to abacavir (ABC) did not have an increased risk of myocardial infarction (MI) or coronary artery disease (CAD) compared to those receiving non-ABC-containing combination antiretroviral therapy (cART).
The study authors combined results from a previous meta-analysis, which included data from 52 Phase 2 through 4 randomized controlled trials (RCTs), with new aggregate data from 14 recent RCTs. The exposure-adjusted incidence rate (IR) and relative rate (RR) of both MI and CAD were compared in patients receiving ABC-containing cART to those receiving non-ABC-containing cART. Primary outcomes of the meta-analysis included ABC-randomized trials with a ≥48-week follow-up and concentrated on MI. Secondary outcomes included both shorter length trials as well as non-ABC-randomized trials, and assessed IR and RR for both MI and CAD.
From the 66 RCTs included in this expanded meta-analysis, a total of 13,119 patients were found to be receiving ABC-containing cART while 7,350 were not. The study authors reported that for the ABC-exposed group, the exposure-adjusted IR for MI was 1.5 per 1,000 person-years (PY) (95% CI: 0.67, 3.34) compared to 2.18 per 1,000 PY (95% CI: 1.09, 4.40) for patients in the unexposed group. The ABC-exposed RR for MI was 0.69 (95% CI: 0.24–1.98).
Additionally, in studies with ≥48 weeks of follow-up, the IR for CAD was 2.9 per 1,000 PY (95% CI: 2.09, 4.02) for patients in the ABC-exposed group vs. 4.69 per 1,000 PY (95% CI: 3.4, 6.47) for patients in the unexposed group (RR: 0.62; 95% CI: 0.39, 0.98). When studies with <48 weeks of follow-up were included, the IR for CAD was 2.96 per 1,000 PY (95% CI: 2.14, 4.08) in the ABC-exposed group vs. 4.65 per 1,000 PY (95% CI: 3.37, 6.42) in the unexposed group (RR: 0.64; 95% CI: 0.4, 1.0).
“This expanded meta-analysis found comparable IRs for MI and CAD among ABC-exposed and unexposed subjects, suggesting no increased risk for MI or CAD following ABC exposure,” the study authors concluded. “These findings provide further evidence against an association between MI and CAD and ABC exposure in this clinical trial population.”
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Nan C, Shaefer MS, Urbaityte R, et al. Abacavir Use and Risk for Myocardial Infarction and Coronary Artery Disease: Updated Meta-analysis of Data from Clinical Trials. Poster presented at IDWeek; October 4–8, 2017; San Diego, CA. http://www.idweek.org