Combination Drugs

COMBINATION DRUGS
Doltegravir/Abaravir/Lamividun
e (TRIUMEQ)
Criteria #
1
2
3
4
Efficacy
Reductionorsupressionof plasmaHIV viral load
IncreaseinCD4count
Resistancetothedrug
Clinical trial evidenceinARTnavepatientswithfavorableresponse
Points
+
+
+
In SINGLE trial, efficacy of DTG/ABC/3TC after 48 weeks, 88% of

patients receiving DTG arm had plasma HIV-RA of <50
copies/mL, shorter median times to viral supression 28 days, and
greater increase in CD4 counts to 268 cells/uL.
Fernandez. (2014, April 28). Dolutegravir, abacavir, and lamivudine as HIV therapy. Retrieved July 28
e (TRIUMEQ)
Criteria
1
2
3
4
Safety
Absenttominimaltemporary/reversiblesideeffects
Absenttominimalriskoforgantoxicityordamage
NoassociatedorrarelifethreateningADRs
Minimaldrug-druginteractions
Points
+
+
+
-
Most commonly reported adverse events in DTG arm were

diarrhea, insomnia, nasopharyngitis and nausea.
Drug interactions with drugs containing magnesium and
aluminum, oral calcium and iron supplements, and metformin.
It is also not recommend with other retroviral drugs such as
etravine and nevirapine
Triumeq. (2015). Retrieved July 3 2015
e (TRIUMEQ)
Criteria
1
2
3
4
Necessity
TargetsbothHIV1and2
Highrateof adherencetothedrug
Convenienceof administration(dosingandschedule)
Nocontraindicationstothehost factorsandconditions
Available for HIV1 infection

Longer serum half-life of 15 hours, which makes possible
one-daily dosing
Triumeq. (2015). Retrieved July 3 2015
Points
+
+
+
e (TRIUMEQ)
Drug
Dosing
Cost/Unit
TotalCost
Doltegravir/Abacavir/ 600mg/50mg/300mg PHP3972/tablet 30tabletsx
Lamividune
tabletonceadayfor
PHP3972=
(Triumeq)
30days
PHP119,160
Rate
++
Cost Considerations and Antiretroviral Therapy . (2015, May 1). Retrieved July 3, 2015, from Guidelines for the Use of Antiretroviral
Agents in HIV-1-Infected Adults and Adolescents: https://www.facebook.com/l.php?u=https%3A%2F%2Faidsinfo.nih.gov
%2Fcontentfiles%2Flvguidelines%2Fglchunk%2Fglchunk_459.pdf&h=LAQFKxpDB
e (TRIUMEQ)
ESNAScorefor
Doltegravir/Abaravir/Lamividune
Efficacy
Safety
Necessity
Affordability
Total
Score
3
3
3
2
11
Tenofovir/Emtricitabine
(TRAVUDA)
Criteria #
1
2
3
4
Efficacy
Reductionor supressionof plasmaviral load
Maintenanceof ahigher CD4count
Minimal resistancetothedrug
Points
+
+
+
+
Virologic suppression (<50 copies/mL) was achieved by Week

24 in the remaining 8 patients. An undetectable viral load was
maintained during > or =60 weeks follow-up.
CD4 count levels increase TDF/FTC + ATV/r (from 206 cells to
324 cells)
Resistance mutation M184V was significantly less common
among patients treated with emtricitabine/tenofovir (14.3%)
Amoroso. (2009, September). Viral load decay in antiretroviral-nave patients receiving once-daily tenofovir and emtricitabine
plus twice-daily nevirapine. Retrieved July 3, 2015, from http://www.ncbi.nlm.nih.gov/pubmed/19906624
V Svicher, C Alteri, A Artese, and others. Different Evolution of Genotypic Resistance Profiles to Emtricitabine Versus Lamivudine
in Tenofovir-Containing Regimens.Journal of Acquired Immune Deficiency Syndromes(Abstract). August 24, 2010
(TRAVUDA)
Criteria
1
2
3
4
Safety
Absenttominimalriskof organtoxicityordamage
Points
+
+
-
Increases in markers of tubular dysfunction were observed in

the tenofovir/emtricitabine arm.
cause new onset of renal impairment such as renal failure and
Fanconis syndrome as well as Immune Reconstitution
Syndrome, changes in body fat, and bone promblems.
Drug to drug interaction occurs with other antiretroviral drug
such as lamivudine, didanosine, atazanavir, darunvair, and
lopinavir
Post FA. (2010, September 15). Randomized comparison of renal effects, efficacy, and safety with once-daily abacavir/lamivudine versus
tenofovir/emtricitabine, administered with efavirenz, in antiretroviral-naive, HIV-1-infected adults: 48-week results from the ASSERT study.
Retrieved July 3, 2015, from NCBI: http://www.ncbi.nlm.nih.gov/pubmed/20431394
(TRAVUDA)
Criteria
1
2
3
4
Necessity
TargetsbothHIV1and2
Nocontraindicationstohost andriskfactors
Points
+
+
+
HIV-1-infected patients (McKeage, 2009)

6% difference in optimal and suboptimal adherance
Because of its long half-life (17 hours), administered once
daily with other antiretroviral drugs.
Ortiz, R. (2008, July 31). ARTEMIS Study: Efficacy and safety of once-daily darunavir/ritonavir versus lopinavir/ritonavir in
treatment-naive HIV-1-infected patients at week 48. Retrieved July 3, 2015, from NATAP:
http://www.natap.org/2008/HIV/071108_02.htm
(TRAVUDA)
Drug
Dosing
Cost/Unit
TenofovirDisoproxil 300mg/200mgtablet PHP2308/tablet
Fumarate/Emtricitabine onceadayfor30
(Travuda)
days
Total Cost
30tabletsx
PHP2308=
PHP69,255
Cost Considerations and Antiretroviral Therapy . (2015, May 1). Retrieved July 3, 2015, from Guidelines for the Use of
Antiretroviral Agents in HIV-1-Infected Adults and Adolescents: https://www.facebook.com/l.php?u=https%3A%2F
%2Faidsinfo.nih.gov%2Fcontentfiles%2Flvguidelines%2Fglchunk%2Fglchunk_459.pdf&h=LAQFKxpDB
Rate
+++
(TRAVUDA)
ESNAScorefor
Tenofovir/Emitricitabine
Score
Efficacy
Safety
Necessity
Affordability
Total
3
3
3
13
Daranuvir/Ritonavir
Criteria #
1
2
3
4
Efficacy
Reductionorsupressionof plasmaviral load
Maintenanceof ahigherCD4count
Resistancetothedrug
Points
+
+
+
+
In MONET trial, 97.6% achieved below 50 copies /mL in the

darunavir/ritonavir monotherapy group
In POWER 1 & 2 trials, achieved a fall in their viral load to below 50
copies/ml. Week 48, 46% taking DRV/R had an undetectable viral
load, compared to only 10% of those taking a comparator drug of
boosted protease inhibitors.
Increase in CD4 cell count being 102 cells/mm3 in the DRV/R arm and
19 cells/mm3 in the comparator arm
Carter, M., & Alcorn, K. (2006, August 2006). CHANGING TREATMENT Darunavir/ritonavir superior virologically and immunologically to
comparator drugs over one year. Retrieved July 4, 2014, from
http://www.aidsmap.com/Darunavirritonavir-superior-virologically-and-immunologically-to-comparator-drugs-over-one-year/page/1424622
/
Hitt, E. (2009, July 21). MONET Trial: Darunavir/Ritonavir Monotherapy Shows Efficacy for HIV Patients With Undetectable Viral Load.
Retrieved July 4, 2015, from Medscape: http://www.medscape.com/viewarticle/706260
Daranuvir/Ritonavir
Criteria
1
2
3
4
Safety
Absenttominimalriskoforgantoxicityordamage
Points
+
-
Daranuvir/Ritonavir
Criteria
1
2
3
4
Necessity
TargetsbothHIV1and2
Nocontraidicationstohostfactorsandconditions
Points
+
+
In ARTEMIS trial, rash-related adverse events: DRV/r (15%) vs

LPV/r (13%) treatment groups There was a case of StevensJohnson syndrome in DRV/r arm)
CYP3A4 inhibitors and substrates: have potential drug
interactions.
Take once a day
Ortiz, R. (2008, July 31). ARTEMIS Study: Efficacy and safety of once-daily darunavir/ritonavir versus lopinavir/ritonavir in treatmentnaive HIV-1-infected patients at week 48. Retrieved July 3, 2015, from NATAP: http://www.natap.org/2008/HIV/071108_02.htm
Daranuvir/Ritonavir
Drug
Daranuvir/Ritonavir
Dosing
Cost/Unit
800mg/100mgtablet PHP2,263/
onceperdayfor30 tablet
days
Total Cost Rate

30tabletsxphp +++
2265=php
67,905
Cost Considerations and Antiretroviral Therapy . (2015, May 1). Retrieved July 3, 2015, from Guidelines for the Use of Antiretroviral
Agents in HIV-1-Infected Adults and Adolescents: https://www.facebook.com/l.php?u=https%3A%2F%2Faidsinfo.nih.gov
%2Fcontentfiles%2Flvguidelines%2Fglchunk%2Fglchunk_459.pdf&h=LAQFKxpDB
Daranuvir/Ritonavir
Criteria #
1
2
3
4
Efficacy
Reductionorsupressionof plasmaHIV1and2viral load
Maintenanceof ahigherCD4count
Resistancetothedrug
Points
+
+
+
+

Combination Drugs

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Combination Drugs

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COMBINATION DRUGS

In SINGLE trial, efficacy of DTG/ABC/3TC after 48 weeks, 88% of

Most commonly reported adverse events in DTG arm were

Available for HIV1 infection

Virologic suppression (<50 copies/mL) was achieved by Week

Increases in markers of tubular dysfunction were observed in

HIV-1-infected patients (McKeage, 2009)

In MONET trial, 97.6% achieved below 50 copies /mL in the

In ARTEMIS trial, rash-related adverse events: DRV/r (15%) vs

Total Cost Rate

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