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Integrated Week 48 Analysis of Efficacy and Safety of Elvitegravir/Cobicistat/Emtricitabine/Tenofovir DF
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Reported by Jules Levin
52nd ICAAC Sept 9-12 2012 SF
D Ward1, G Crofoot2, D Shamblaw3,
N Bellos4, C Kinder5, S Chen6, MS Rhee6,J Szwarcberg6
DupontCircle Physicians Group, Washington, DC;
Gordon E. Crofoot, MD, PA, Houston, TX; La Playa Medical Group and Clinical Research, San Diego, CA; Southwest Infectious Disease Clinical Research., Dallas, TX; Kinder Medical Group, Miami, FL; Gilead Sciences, Foster City, CA
ABSTRACT
Background: Elvitegravir/cobicistat/emtricitabine/tenofovir DF ("QUAD") demonstrated noninferior efficacy (margin: -12%) to EFV/FTC/TDF [ATR] (study 102 and 104) and to ritonavir-boosted atazanavir in combination with TDF/FTC [ATV/r+TVD] (study 103) by snapshot analysis at Week (Wk) 48 in randomized, controlled trials of HIV-infected treatment naïve subjects.
Methods: Integrated analysis of efficacy and safety.
Results: Subjects had similar baseline characteristics (QUAD n=749; ATR n=375; ATV/r+TVD n=355). The rates of virologic suppression (HIV-1 RNA < 50 c/mL) at Wk 48 in QUAD, ATR, and ATV/r+TVD were 88.8, 84.0, and 86.8%; the difference was 5.1% (95% CI: 0.7 to 9.4) between QUAD and ATR; and 1.9% (-2.3 to 6.1) between QUAD and ATV/r + TVD. QUAD efficacy was consistent across subgroups based on demographics, baseline HIV-1 RNA, and CD4 cells. The rates of adverse events (AEs) leading to study drug discontinuation were similar in the 3 groups (QUAD vs ATR vs ATV/r+TVD) (3.5 vs 5.1 vs 5.1%), as were those of serious AEs (9.2 vs 6.7 vs 8.7 %), and deaths (0.1 vs 0.5 vs 0.8%). Fewer QUAD subjects, compared to ATR, reported neuropsychiatric AEs (QUAD vs ATR: 42.9 vs 62.1%; p<0.001) and rash AEs (17.5 vs 27.7%; p<0.001). At Wk 48, a small increase in creatinine (median, mg/dL) was seen in QUAD (+0.13) and ATV/r+TVD (+0.08), but not in ATR (+0.01). These changes were seen as early as Wk 2, and stabilized through Wk 48. QUAD had less increase (median, mg/dL) in total cholesterol (+10 vs +19; p<0.001), LDL (+10 vs +17; p<0.001), and HDL (+5 vs +8; p=0.002), compared to ATR; QUAD also had less increase in triglyceride (+8 vs +23; p=0.006), compared to ATV/r+TVD.
Conclusions: QUAD, a new single tablet regimen, demonstrated high rates of virologic suppression comparable to ATR and ATV/r+TVD with potential to overcome toxicities, such as neuropsychiatric symptoms, rash, and hyperlipidemia. Early small increase in creatinine that stabilizes is expected with QUAD due to COBI's inhibition of renal creatinine tubular secretion.
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