Neuropsychiatric adverse events (NPAEs) observed with the integrase strand transfer inhibitor (INSTI) dolutegravir (DTG) are usually mild to moderate. The most prevalent symptoms are insomnia and sleep disorders, but the spectrum also includes dizziness, anxiety, depression, headache, paraesthesia, muscle-skeletal pain, poor concentration, and slow thinking. In recent cohort studies involving >6400 patients in different countries, discontinuation rates due to NPAEs were observed in around 3.5% (range, 1.4-7.2%) of subjects treated with DTG. These rates have been higher than those seen in randomized clinical trials and were also higher than with other INSTIs such as elvitegravir or raltegravir. Elderly, female patients and those who initiate abacavir simultaneously appear to be more vulnerable in some cohorts. It remains unclear if NPAEs are driven by an increased DTG exposure. With heightened awareness of health-care providers and patients, reports of NPAEs will probably increase in the future.

中文翻译：

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使用Dolutegravir和其他整合酶链转移抑制剂的神经精神不良事件

用整合酶链转移抑制剂（INSTI）多洛格韦（DTG）观察到的神经精神不良事件（NPAE）通常为轻度至中度。最普遍的症状是失眠和睡眠障碍，但频谱还包括头晕，焦虑，抑郁，头痛，感觉异常，肌肉骨骼疼痛，注意力不集中和思维缓慢。在最近涉及不同国家的6400多例患者的队列研究中，在约3.5％（1.4-7.2％的范围）接受DTG治疗的受试者中观察到由于NPAE导致的停药率。这些比率高于随机临床试验中观察到的比率，也高于其他INSTIs（如elvitegravir或raltegravir）。在某些人群中，女性老年人和那些开始使用阿巴卡韦的患者同时显得更脆弱。尚不清楚NPAE是否由增加的DTG暴露所驱动。随着对医疗服务提供者和患者意识的增强，NPAE的报告将来可能会增加。