Etravirine Good Tx Switch Option in HIV (CME/CE)
The non-nucleoside reverse transcriptase inhibitor etravirine (Intelence) is a good option for HIV patients who can't or don't want to tolerate their current drug regimen, a researcher said here.
In a retrospective cohort analysis, patients switching with an undetectable HIV viral load -- usually because of adverse effects -- were able to maintain viral suppression, according to Lauren Bull, MD, of Chelsea and Westminster Hospital in London.
And more than half of those who switched with a detectable viral load were able to suppress the virus while on etravirine and a background of two other drugs, Bull reported at the 7th International AIDS Society Conference on HIV Pathogenesis, Treatment, and Prevention.
Over a 4-year period from 2008 through 2012, Bull and her colleagues switched 389 patients to etravirine plus two other drugs, including 345 with a plasma viral load of fewer than 50 copies of HIV RNA per milliliter.
Another 44 had viral loads higher than that cut-off, she reported.
Among the patients with an undetectable viral load, Bull said, 61% had been on the single-pill combination of efavirenz, tenofovir, and emtricitabine (Atripla), 11% were on another efavirenz-based regimen, and 19% had been on therapy based on protease inhibitors.
The main reason for switching from efavirenz-based regimens was the central nervous system side effects of the drug, Bull reported, while those wanting to move away from protease inhibitors cited such things as diarrhea and weight gain.
While some patients in turn switched away from etravirine, it was very rarely because the virus escaped control -- between 96% and 100% of patients maintained a suppressed viral load, Bull said, and only four suffered virological failure.
Most patients who switched the second time also cited toxicities, of which the most common were central nervous system effects, she added.
Among the 44 patients who had detectable virus when they started etravirine, 17 had been on efavirenz and all cited central nervous system side effects as a reason for change, Bull reported.
And 28 of the 44 were able to completely suppress their virus and remain with an undetectable viral load for up to 3 years, she said. The proportion with an undetectable viral load ranged from 0% (just after the switch) to 90% (after 3 years).
The findings are not surprising since etravirine has been shown to be an effective drug, commented Pedro Cahn, MD, of Fundación Huesped in Buenos Aires and a former president of the IAS.
It's good enough, he told MedPage Today
, that it could be used in the first-line setting, if it were not that its sister drug, rilpivirine (Edurant), is regarded as being even better.
But etravirine has the advantage that it is not affected by the K103N mutation, the most common HIV mutation that confers resistance to non-nucleoside reverse transcriptase inhibitors.
Bull did not report external support for the study or make any disclosures.
Cahn has reported financial links with Abbott, Pfizer, GlaxoSmithKline, Pharmacia, and Roche.
Primary source: International AIDS Society
Source reference:
Bull L, et al "Long term therapeutic success of etravirine in switch and naive patients" IAS
2013; Abstract WEAB0105.
