Neural tube defects with Dolutegravir-based HIV medications

May 22, 2018 –The American Food and Drug Administration (FDA) just released a Safety Alert concerning serious neural tube defects that might arise in babies born to women who took HIV medications that contained the active ingredient Dolutegravir. Neural tube defects are birth defects that can occur early in pregnancy when the spinal cord, brain, and related structures do not form properly.

In the US, Dolutegravir is available as a single ingredient product under the brand name Tivicay and as a fixed dose combination tablet with other HIV medicines under the brand names Juluca and Triumeq. In the European Union (EU), Tivicay and Triumeg are also approved, while approval of Juluca is pending.

According to this alert, serious cases of neural tube defects (NTDs) involving the brain, spine, and spinal cord have been reported in babies born to women treated with dolutegravir used to treat human immunodeficiency virus (HIV) in an ongoing observational study in Botswana. Preliminary results of this study in African country of Botswana indicated that women who received Dolutegravir at the time of becoming pregnant or early in the first trimester of pregnancy appeared to be at higher risk for these defects, while there were no reported cases of babies born with neural tube defects to women starting Dolutegravir later in pregnancy.

Following this safety alert, the FDA urgently recommends the following:

  • Patients should not stop taking Dolutegravir without first talking to your health care professional because stopping your medicine can cause the HIV infection to worsen. In addition:
  • If you are already pregnant, stopping your Dolutegravir-containing regimen without switching to alternative HIV medicines could cause the amount of virus to increase and spread HIV to your baby.
  • If you take a Dolutegravir-containing regimen at the time of becoming pregnant and during the first trimester of pregnancy, there is a risk that your baby may develop neural tube defects. Neural tube defects happen early in pregnancy, before many women even know they are pregnant. For this reason, women of childbearing age should talk to their health care professional about other non-Dolutegravir-containing antiretroviral medicines.
  • You should tell your health care professional if you are pregnant or are planning to become pregnant before you start a Dolutegravir-containing regimen. Your health care professional may discuss other treatment options with you.
  • Women of childbearing age who decide to take a Dolutegravir-containing regimen should consistently use effective birth control (contraception) while on HIV treatment. Women should talk to their health care professionals about an effective birth control method to use while taking a dolutegravir-containing regimen.
  • Before you start a Dolutegravir-containing regimen you will need a pregnancy test to determine if you are already pregnant.

Healthcare professionals should inform women of childbearing age about the potential risk of neural tube defects when a Dolutegravir-containing regimen is used at the time of conception and early in pregnancy. In addition:

  • Healthcare professionals should weigh the benefits and the risks of Dolutegravir when prescribing antiretroviral medicines to women of childbearing age. Alternative antiretroviral medicines should be considered. Discuss the relative risks and benefits of appropriate alternative antiretroviral therapies.
  • If the decision is made to use Dolutegravir in women of childbearing age, health care professionals should reinforce the consistent use of effective birth control.
  • Perform pregnancy testing before initiating a Dolutegravir-containing regimen in women of childbearing age to exclude pregnancy.

Healthcare professionals and patients are encouraged to report adverse events or side effects related to the use of these products to the FDA’s MedWatch Safety Information and Adverse Event Reporting Program at  www.fda.gov/MedWatch/report.

Cave: Since HIV/AIDS is present on a global scale and huge numbers of HIV-afflicted patients are not US-based, the present information by the FDA should be propagated to authorities, treating physicians, health care professionals and patients alike worldwide in an appropriate manner (e.g., translations, isolated geographical locations, etc.) as fast as possible, given the seriousness of these effects of Dolutegravir-containing medicines.

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About the Author
Joseph Gut - thasso Ph.D.; Professor in Pharmacology and Toxicology. Senior expert in theragenomic and personalized medicine and individualized drug safety. Senior expert in pharmaco- and toxicogenetics. Senior expert in human safety of drugs, chemicals, environmental pollutants, and dietary ingredients.

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