Effects of efbemalenograstim alfa-vuxw injection: A Synthesis of Findings from 7 Studies

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Original Abstract of the Article

Major Research Findings

Efavirenz is a well-known antiretroviral drug used in HIV treatment, but it can have cognitive side effects. Even asymptomatic patients who switch medications for reasons other than neurocognitive complaints have reported subjective improvements in cognitive function after discontinuing efavirenz. 7 A randomized controlled trial aimed to assess the effect of switching from Atripla (TDF/FTC/EFV) to Eviplera (TDF/FTC/RPV) on cognition, hypothesizing an improvement with efavirenz discontinuation. The study suggested an improvement in cognition when discontinuing efavirenz. 7 However, another study comparing efavirenz to etravirine found no significant differences in patient preference, sleep, anxiety, or lipid levels when switching from efavirenz to etravirine. 2 Long-term use of efavirenz demonstrated an improvement in neuropsychological performance over three years; however, a slight increase in efavirenz-associated central nervous system symptoms, bad dreams, and anxiety was detected. 1 Additionally, valerian showed significant improvements in sleep and anxiety among HIV-positive patients in the first four weeks of treatment with efavirenz. 5 The dosage and blood levels of efavirenz may impact cognitive function, highlighting the need for further investigation. 4 A systematic review indicated that efavirenz might be neurotoxic and contribute to cognitive impairment. 3 These research findings suggest that efavirenz may influence cognitive function, emphasizing the need for personalized treatment plans for individual patients.

Benefits and Risks

Benefit Summary

Discontinuing efavirenz might lead to improvements in cognitive function. However, the improvement effect can vary among individuals. Switching efavirenz to other medications might not necessarily improve cognitive function. Nevertheless, long-term use of efavirenz may not worsen cognitive function. 1 Additionally, discontinuing efavirenz could improve sleep and anxiety. 5

Risk Summary

While discontinuing efavirenz may improve cognitive function, it could also increase efavirenz-related side effects like bad dreams and anxiety. 1 Furthermore, starting efavirenz treatment may lead to side effects like dizziness and nausea. 5

Comparison Across Studies

Commonalities in Studies

Multiple studies suggest that efavirenz may impact cognitive function. Patients taking efavirenz might experience improvements in sleep and anxiety. Additionally, starting efavirenz treatment may result in side effects like dizziness and nausea.

Differences in Studies

While some studies suggest improvements in cognitive function after discontinuing efavirenz, others indicate that switching efavirenz to other medications does not necessarily improve cognitive function. Some research suggests that long-term efavirenz use does not worsen cognitive function. Additionally, while some studies report improved sleep and anxiety after discontinuing efavirenz, others show increased efavirenz-related side effects like bad dreams and anxiety.

Consistency and Contradictions in Results

Multiple studies suggest that efavirenz may impact cognitive function. However, the effect of discontinuing efavirenz on cognitive improvement is not consistent across studies. While some studies show improvement, others suggest that switching efavirenz to other medications doesn’t necessarily improve cognition. These discrepancies require further research to be resolved.

Caution in Applying Results to Real Life

Taking efavirenz may affect cognitive function, so it is crucial to be cautious. Patients taking efavirenz should be vigilant when performing tasks that require focus and judgment, such as driving or operating machinery. Discontinuing efavirenz may improve cognitive function, but it may also increase efavirenz-related side effects like bad dreams and anxiety. Therefore, patients should consult their doctor before stopping efavirenz to discuss appropriate actions.

Limitations of Current Research

Research on the effects of efavirenz on cognitive function is still insufficient. Further research is needed to clarify the effect of discontinuing efavirenz on cognitive improvement. It is also crucial to explore the potential impact of dosage and blood levels of efavirenz on cognitive function. More studies are necessary to address these aspects.

Future Research Directions

Further research is crucial to explore the impact of efavirenz on cognitive function. Large clinical trials are essential to clarify the effect of discontinuing efavirenz on cognitive improvement. Furthermore, pharmacokinetic and pharmacodynamic analyses are needed to determine the influence of efavirenz dosage and blood levels on cognitive function.

Conclusion

Efavirenz is an antiretroviral drug that may influence cognitive function. It’s essential to be cautious when considering efavirenz treatment, being aware of potential cognitive effects. While discontinuing efavirenz may improve cognitive function, it may also increase efavirenz-related side effects like bad dreams and anxiety. Consulting your doctor before stopping efavirenz is recommended to discuss appropriate actions. Further research is needed to thoroughly understand the effects of efavirenz on cognitive function.

Literature analysis of 7 papers
Positive Content
5
Neutral Content
2
Negative Content
0
Article Type
6
0
1
1
7
1.

Long-term impact of efavirenz on neuropsychological performance and symptoms in HIV-infected individuals (ACTG 5097s).

Author: CliffordDavid B, EvansScott, YangYijun, AcostaEdward P, RibaudoHeather, GulickRoy M,

Improved neuropsychological performance
Increased CNS symptoms
Increased anxiety

In patients continuing EFV-based regimens for more than 3 years, neuropsychological performance improved from baseline and was maintained. However, small increases in EFV-associated symptoms, bad dreams, and anxiety were observed.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, N.I.H., ExtramuralResearch funding provided by the NIH to external research institutions and researchers.

Language : English

2.

A randomized crossover study to compare efavirenz and etravirine treatment.

Author: NguyenAlain, CalmyAlexandra, DelhumeauCécile, MercierIsabelle K, CavassiniMatthias, Fayet-MelloAurélie, ElziLuigia, GennéDaniel, RauchAndri, BernasconiEnos, HirschelBernard,

Reduced cholesterol

This study found that patients did not express a significant preference for etravirine over efavirenz after substitution. There was no measurable effect on neuropsychiatric symptoms and sleep. Cholesterol levels decreased after replacing efavirenz with etravirine.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

3.

Neuronal toxicity of efavirenz: a systematic review.

Author: DecloedtEric H, MaartensGary

Neurocognitive improvement
Cognitive impairment
Neuron damage
Neuropsychiatric side effects

Efavirenz may contribute to cognitive impairment by damaging nerve cells. Further research is needed to confirm this effect.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
ReviewAn article that critically examines existing research on a particular topic and summarizes the current state of knowledge in the field.
Systematic ReviewA review that systematically collects, evaluates, and integrates relevant research to answer a specific research question.

Language : English

4.

Pharmacokinetic and Pharmacodynamic Comparison of Once-Daily Efavirenz (400 mg vs. 600 mg) in Treatment-Naïve HIV-Infected Patients: Results of the ENCORE1 Study.

Author: DickinsonL, AminJ, ElseL, BoffitoM, EganD, OwenA, KhooS, BackD, OrrellC, ClarkeA, LossoM, PhanuphakP, CareyD, CooperD A, EmeryS, PulsR,

HIV suppression
Efavirenz side effects

Efavirenz 400mg daily was as effective as 600mg daily in suppressing HIV in treatment-naïve patients, despite significantly lower exposure at the lower dose. 97% of patients on 400mg and 98% of patients on 600mg achieved a viral load below 200 copies/mL after 48 weeks.

Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

5.

Effect of Valerian in Preventing Neuropsychiatric Adverse Effects of Efavirenz in HIV-Positive Patients: A Pilot Randomized, Placebo-Controlled Clinical Trial.

Author: AhmadiMotahareh, KhaliliHossein, AbbasianLadan, GhaeliPadideh

Improved sleep
Reduced anxiety
Dizziness
Nausea

Valerian significantly improved sleep and anxiety in HIV-positive patients receiving efavirenz. Valerian may be a potential option for preventing neuropsychiatric adverse effects of efavirenz.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.

Language : English

6.

Increased cholesterol absorption rather than synthesis is involved in boosted protease inhibitor-associated hypercholesterolaemia.

Author: LeyesPere, CofanMontserrat, González-CordónAna, de LazzariElisa, TrabalJoan, DomingoPere, NegredoEugenia, VidalFrancesc, ForgaMaria T, GatellJose M, RosEmili, MartínezEsteban

Increased cholesterol

Ritonavir-boosted lopinavir (LPV/r)-based therapy increased total cholesterol levels compared to efavirenz (EFV)-based therapy in HIV-infected patients. The increased total cholesterol levels were likely due to increased cholesterol absorption rather than increased cholesterol synthesis.

Clinical TrialA clinical trial is a planned study conducted on humans to evaluate the efficacy and safety of pharmaceuticals, medical devices, and treatment methods. It aims to explore the possibilities of new treatments and improve the health of patients.
Comparative StudyResearch that compares multiple groups/interventions to determine differences/similarities in outcomes/characteristics.
Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Multicenter StudyResearch conducted in collaboration with multiple research institutions. It aims to collect a wide range of data and obtain more generalizable results.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

7.

Objective and Subjective Improvement of Cognition After Discontinuing Efavirenz in Asymptomatic Patients: A Randomized Controlled Trial.

Author: HakkersCharlotte S, ArendsJoop E, van den BerkGuido E, EnsingMonique H M, HooijengaImke, VinkMatthijs, van ZandvoortMartine J E, HoepelmanAndy I M

Improved cognitive functioning
Cognitive side effects

This study assessed the effect on cognition of switching Atripla (TDF/FTC/EFV) to Eviplera (TDF/FTC/RPV), hypothesizing an improvement when discontinuing efavirenz.

Journal ArticleAn article published in an academic or professional journal that reports original research or scholarly analysis.
Randomized Controlled TrialA clinical trial that randomly assigns participants to treatment and control groups to evaluate the effects of an intervention.
Research Support, Non-U.S. Gov'tResearch funding provided by government agencies outside the United States.

Language : English

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