Recently, published studies
have reported conflicting results regarding the association between efavirenz
exposure and the risk of suicidality among patients with human immunodeficiency
virus.
The objective of this analysis was to compare the rate of suicidality
among patients initiating efavirenz-containing versus efavirenz-free
antiretroviral (ARV) regimens.This retrospective cohort study used US
administrative claims data for commercially and Medicaid-insured individuals for
the years 2006 to 2013. ARV-naive patients aged ≥12 years initiating an
efavirenz-containing or efavirenz-free ARV regimen with ≥6 months of continuous
insurance enrollment prior to ARV initiation were selected. The primary outcome
was suicidality, defined as the occurrence of any medical claim with a
diagnosis code for suicidal ideation or an inpatient or emergency department
medical claim for suicide attempt. Unadjusted incidence rates were calculated
and propensity score-adjusted hazard ratios were estimated to account for
differences in patient characteristics.
There were 19,983 patients
(efavirenz-containing, n = 11,187; efavirenz-free, n = 8796) in the commercial
database and 5154 patients (efavirenz-containing, n = 2224; efavirenz-free,
n = 2930) in the Medicaid database. Unadjusted incidence rates (95% confidence
interval [CI]) of suicidality per 1000 person-years were: commercial,
efavirenz-containing (3.3 [2.4-4.4]), efavirenz-free (4.0 [2.7-5.8]); Medicaid,
efavirenz-containing (25.7 [18.8-34.4]), efavirenz-free (40.6 [31.9-50.9]). In
propensity score-adjusted analyses, efavirenz use was not associated with
suicidality: adjusted hazard ratio (95% CI) of suicidality compared with
efavirenz-free regimen, commercial, 1.029 (0.636-1.665); Medicaid, 0.902
(0.617-1.319).
This analysis found no conclusive evidence of an increased risk
of suicidality among patients initiating an efavirenz-containing ARV regimen.
However, channeling bias may exist even after adjusting for measured patient
characteristics.
Below: Cumulative hazards of suicidality in the (A) commercial and (B) Medicaid databases. EFV = efavirenz.
Full article at: http://goo.gl/Ml67m4
By: Nkhoma ET1, Coumbis J, Farr AM, Johnston SS, Chu BC, Rosenblatt LC, Seekins D, Villasis-Keever A.
- 1From the Bristol-Myers Squibb, Global Pharmacovigilance and Epidemiology, Wallingford, Connecticut (ETN); Bristol-Myers Squibb, Global Pharmacovigilance and Epidemiology, Hopewell, New Jersey (JC, DS); Truven Health Analytics, Bethesda, Maryland (AMF, SSJ, BCC); Bristol-Myers Squibb, Health Economics and Outcomes Research (LCR); and Bristol-Myers Squibb, US Medical, Plainsboro, New Jersey (AV-K).
- Medicine (Baltimore). 2016 Jan;95(3):e2480. doi: 10.1097/MD.0000000000002480.
More at: https://twitter.com/hiv insight

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