{"id":3042,"date":"2019-12-17T08:59:44","date_gmt":"2019-12-17T14:59:44","guid":{"rendered":"https:\/\/blog.unmc.edu\/infectious-disease\/?p=3042"},"modified":"2019-12-13T13:58:34","modified_gmt":"2019-12-13T19:58:34","slug":"pharmtoexamtable-what-do-we-know-about-etravirine-for-hiv","status":"publish","type":"post","link":"https:\/\/blog.unmc.edu\/infectious-disease\/2019\/12\/17\/pharmtoexamtable-what-do-we-know-about-etravirine-for-hiv\/","title":{"rendered":"PharmToExamTable: What do we know about Etravirine for HIV?"},"content":{"rendered":"

\"\"Recently, several of our HIV pharmacist colleagues in our Division of Infectious Diseases at UNMC\/Nebraska Medicine, published an invited review in Clinical Pharmacokinetics entitled: Clinical Pharmacokinetics and Pharmacodynamics of Etravirine: An Updated Review<\/a>.\u00a0 The first author, Dr. Josh Havens PharmD, wrote this summary describing the review article.<\/em><\/p>\n

What prompted the review?<\/strong><\/p>\n

This was an invited review, but there was only one previously completed shortly after etravirine\u2019s FDA approval in 2009.<\/p>\n

What do we know about the role of etravirine in ART regimens today?<\/strong><\/p>\n

Etravirine was initially brought to market as an additional agent to be used in conjunction with ritonavir-boosted darunavir in patients who were on failing regimens.\u00a0 In the phase III, DUET-1<\/a> and -2<\/a> trials, the addition of etravirine to an optimized background regimen resulted in significantly greater improvements in HIV viral suppression.<\/p>\n

In the US, etravirine\u2019s use has declined secondary to the advent of integrase strand transfer inhibitors and etravirine\u2019s twice daily dosing frequency.\u00a0 Further, etravirine exhibits significant potential for bi-directional drug-drug interactions with other antiretrovirals as well as concomitant medications.\u00a0 In other countries, specifically in Europe, etravirine has been used with once-daily dosing.\u00a0 In pharmacokinetic studies, etravirine once-daily did not significantly differ from twice daily dosing by systemic exposure (AUC), but resulted in slightly higher max concentations (Cmax) and slightly lower trough concentrations (Cmin).<\/p>\n

Etravirine has also been studied in small populations of antiretroviral na\u00efve patients with variable results.\u00a0 In comparison to DHHS guideline recommended antiretroviral regimens, etravirine use in na\u00efve populations was less favorable by efficacy measures.\u00a0 As a result, we still see etravirine\u2019s use in the same way it was initially approved.\u00a0 Once-daily dosing may be favorable in some patients to improve adherence granted that therapeutic drug monitoring may be available to verify sufficient etravirine plasma concentrations. Additionally, etravirine is now approved for use in children down to 2 years old with weight based dosing (BID only) and offers an additional agent in the form of a dissolvable tablet for use in this population.<\/p>\n

What are the high-level take-aways about how\/when to use etravirine?<\/strong><\/p>\n

Europe uses therapeutic drug monitoring more readily for ART than the US and thus uses once daily etravirine more frequently.\u00a0 Given our stance on refraining from its use in na\u00efve populations with a regimen such as ETR + F\/TAF, as was done in the UNC study (78% VS rates at week 48), we feel the most likely patient that would use etravirine would be someone with some resistance and the risk of using once daily etravirine in this type of patient would likely be greater than its benefit.<\/p>\n

What is the biggest gap in the science\/knowledge about the role of etravirine in ART?<\/strong><\/p>\n

Further studies of etravirine use once daily in both adults and children may be warranted.\u00a0 Given the efficacy of INI\u2019s, we don\u2019t feel that ETR has a place in na\u00efve regimens.<\/p>\n

Read the full study here:\u00a0<\/strong>Havens, J.P., Podany, A.T., Scarsi, K.K. et al. Clin Pharmacokinet (2019). https:\/\/doi.org\/10.1007\/s40262-019-00830-9<\/a><\/p>\n<\/div><\/div>","protected":false},"excerpt":{"rendered":"

Recently, several of our HIV pharmacist colleagues in our Division of Infectious Diseases at UNMC\/Nebraska Medicine, published an invited review in Clinical Pharmacokinetics entitled: Clinical Pharmacokinetics and Pharmacodynamics of Etravirine: An Updated Review.\u00a0 The first author, Dr. Josh Havens PharmD, wrote this summary describing the review article. What prompted the review? This was an invited […]<\/p>\n","protected":false},"author":562,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"_s2mail":"yes","footnotes":""},"categories":[4,64,69,9,130,57],"tags":[63,58,25,70,17,3],"class_list":["post-3042","post","type-post","status-publish","format-standard","hentry","category-faculty-and-staff","category-hiv-aids","category-id-pharmacy","category-journal-club","category-pharmtoexamtable","category-unmc-scc","tag-aidsawareness","tag-hiv","tag-learnid","tag-pharmtoexamtable","tag-unmchiv","tag-unmcid"],"_links":{"self":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/3042","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/users\/562"}],"replies":[{"embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/comments?post=3042"}],"version-history":[{"count":4,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/3042\/revisions"}],"predecessor-version":[{"id":3127,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/posts\/3042\/revisions\/3127"}],"wp:attachment":[{"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/media?parent=3042"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/categories?post=3042"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blog.unmc.edu\/infectious-disease\/wp-json\/wp\/v2\/tags?post=3042"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}