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Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy

Jordan, Rachel, Gold, Lisa, Cummins, Carole and Hyde, Chris 2002, Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy, BMJ, vol. 324, no. 7340, pp. 757-766.

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Title Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy
Author(s) Jordan, Rachel
Gold, Lisa
Cummins, Carole
Hyde, Chris
Journal name BMJ
Volume number 324
Issue number 7340
Start page 757
End page 766
Publisher BMJ Publishing Group
Place of publication London, England
Publication date 2002-03-30
ISSN 0959-535X
Summary Objective: To assess the evidence for the effectiveness of increasing numbers of drugs in antiretroviral combination therapy.

Design: Systematic review, meta-analysis, and meta-regression of fully reported randomised controlled trials. All studies included compared quadruple versus triple therapy, triple versus double therapy, double versus monotherapy, or monotherapy versus placebo or no treatment.

Participants: Patients with any stage of HIV infection who had not received antiretroviral therapy.

Main outcome measures: Changes in disease progression or death (clinical outcomes); CD4 count and plasma viral load (surrogate markers).
Search strategy: Six electronic databases, including Medline, Embase, and the Cochrane Library, searched up to February 2001.

Results: 54 randomised controlled trials, most of good quality, with 66 comparison groups were included in the analysis. For both the clinical outcomes and surrogate markers, combinations with up to and including three (triple therapy) were progressively and significantly more effective. The odds ratio for disease progression or death for triple therapy compared with double therapy was 0.6 (95% confidence interval 0.5 to 0.8). Heterogeneity in effect sizes was present in many outcomes but was largely related to the drugs used and trial quality.

Conclusions: Evidence from randomised controlled trials supports the use of triple therapy. Research is needed on the effectiveness of quadruple therapies and the relative effectiveness of specific combinations of drugs.
Notes This article has been published in the BMJ : Jordan, Rachel, Gold, Lisa, Cummins, Carole and Hyde, Chris 2002-03-30, Systematic review and meta-analysis of evidence for increasing numbers of drugs in antiretroviral combination therapy, BMJ, vol. 324, no. 7340, pp. 757-766., and can also be viewed on the journal’s website at www.bmj.com
Language eng
Field of Research 110309 Infectious Diseases
HERDC Research category C1.1 Refereed article in a scholarly journal
Copyright notice ©2002, BMJ Group
Persistent URL http://hdl.handle.net/10536/DRO/DU:30006602

Document type: Journal Article
Collections: School of Health and Social Development
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