Case-03: Marketing

Introducing Past Case Studies using Data from MDV Database.

Case Study (Marketing)

Switch Rates, Time-to-switch, and Switch Patterns of Antiretroviral Therapy in People Living with Human Immunodeficiency Virus in Japan, using a Hospital-claim Database


Ruzicka DJ, Kuroishi N, Oshima N, et al. Switch rates, time-to-switch, and switch patterns of antiretroviral therapy in people living with human immunodeficiency virus in Japan, in a hospital-claim database. BMC Infect Dis. 2019;19(1):505. Published 2019 Jun 10. doi:10.1186/s12879-019-4129-6


  • Antiretroviral therapy (ART) contributes to extend HIV patient’s life expectancy
  • Combination of the following medications have been the recommended regimen in Japanese guidelines:
    • Backbone therapy: 2 nucleoside reverse transcriptase inhibitors
    • Add on of an anchor drug among:
      • a.Integrase strand transfer inhibitors (INSTIs)
      • b.Non-nucleoside reverse transcriptase inhibitors (NNRTIs)
      • c.Protease inhibitors (PIs)
      • d.Entry inhibitors (Els)

Objectives of Study

To understand the switch rates and time-to-switch of ART regimens in patients with HIV between 2008 to 2016 in Japan

Study Design and Criteria

Study Design: Retrospective Observational Database Study.

Target Period: April 2008 - December 2016


Definition of Regimen Switch

Regimen switch is referring to only when adopting anchor drug classes.
Change in anchor drug classes within 28 days of a different anchor drug is considered a change in regimen.


Patient Disposition


Distributions of anchor drug class and backbone in the ART regimens by year

case_studies03_img_06.png case_studies03_img_07.png

Switching Patterns and Timing

Switching patterns of anchor drug class in ART regimens by switching timing from 2011 to 2016



Time-to-switch of ART regimens according to anchor drug class from 2011 to 2016



  • An ART regimen including INSTI maintained a low switch rate for long duration.
  • The major switch was seen mainly from NNRTI or PI to INSTI for secondary treatment suggesting INSTI is rather a tentative treatment approach for HIV patients

Service used for the Case Study:

Abbreviation in Article

  • 3TCLamivudine
  • ABCAbacavir
  • AEAdverse event
  • ARTAntiretroviral therapy
  • ATV/rAtazanavir/ritonavir
  • AZTZidovudine
  • CIConfidence interval
  • DTGDolutegravir
  • EFVEfavirenz
  • EIEntry inhibitor
  • FTCEmtricitabine
  • HIVHuman immunodeficiency virus
  • HRHazard ratio
  • ICD-10The International Statistical Classification of Diseases and Related Health Problems 10th Revision
  • INSTIIntegrase strand transfer inhibitor
  • NNRTINon-nucleoside reverse transcriptase inhibitor
  • NRTINucleoside reverse transcriptase inhibitor
  • PIProtease inhibitor
  • PLWHPeople living with human immunodeficiency virus
  • TAFTenofovir alafenamide fumarate
  • TDFTenofovir disoproxil fumarate

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