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Etravirine

Classification: A

Drug products: INTELENCE

ATC code: J05AG04

Substances: etravirine

Summary

Few women were included in the pivotal studies and no relevant sex analysis regarding the effect of etravirine has been found. Rash has been reported to be more common in women.
 
In our opinion, the described differences do not motivate differentiated dosing or treatment in men and women.

Additional information

Antiretrovirals for treatment of HIV are always given as a combination of at least three medicines. Cobicistat is used to boost the effect of other antiretroviral drugs. As studies on HIV patients always include patients receiving combination therapy it is difficult to know which of the studied medicines that cause changes in effect and/or adverse events.

Pharmacokinetics and dosing

The manufacturer reports no significant pharmacokinetic differences between men and women but concludes that a limited number of women were included in the studies [1].

Effects

Both men and women have been included in the pivotal studies although the number of women was low, in the DUET study (1072 men, 131 women) [2]. No clinically relevant sex analysis regarding the effect of etravirine has been performed.

Adverse effects

The manufacturer reports rash to be more frequent in women treated with etravirine than in men [1]. In the DUET study (1072 men, 131 women) 15% and 9%, respectively in women and men had rash [2]. The severity was similar in men and women and there was no significant difference in discontinuations due to rash [2].

Reproductive health issues

Regarding teratogenic aspects, please consult the Drugs and Birth Defects Database (in Swedish, Janusmed fosterpåverkan).

Other information

A review has described drug exposure in the genital tract of men and women which is of interest in viral transferal and in effect of pre-exposure prophylactic treatment. In men, concentrations in seminal fluid were described to be highest for nucleoside analogues and lowest for protease inhibitors and efavirenz. Seminal accumulation of raltegravir and maraviroc was defined as moderate. The rank order of accumulation presented in the review is nucleoside/nucleotide reverse transcriptase inhibitors [lamivudine/zidovudine/tenofovir/didanosine > stavudine/abacavir] > raltegravir > indinavir/maraviroc/nevirapine >> efavirenz/protease inhibitors [amprenavir/atazanavir/darunavir > lopinavir/ritonavir > saquinavir] > enfuvirtide. In the female genital tract, the nucleoside analogues also were described as having high accumulation ratios, whereas protease inhibitors have limited penetration; however, substantial variability exists. Second generation non-nucleoside reverse transcriptase inhibitor etravirine, and maraviroc and raltegravir, have been found to demonstrate effective accumulation in cervicovaginal secretions. The rank of accumulation presented in the review is nucleoside/nucleotide reverse transcriptase inhibitor [zidovudine/lamivudine/didanosine > emtricitabine/tenofovir] > indinavir > maraviroc/raltegravir/darunavir/etravirine > nevirapine/abacavir > protease inhibitors [amprenavir/atazanavir/ritonavir] > lopinavir/stavudine/efavirenz > saquinavir [3].

Updated: 2019-02-26

Date of litterature search: 2018-07-18

References

  1. Intelence (etravirine). Summary of Product Charateristics. European Medicines Ageny (EMA); 2018.
  2. Girard PM, Campbell TB, Grinsztejn B, Hartikainen J, Rachline A, Nijs S et al. Pooled week 96 results of the phase III DUET-1 and DUET-2 trials of etravirine: further analysis of adverse events and laboratory abnormalities of special interest. HIV Med. 2012;13(7):427-35. PubMed
  3. Else LJ, Taylor S, Back DJ, Khoo SH. Pharmacokinetics of antiretroviral drugs in anatomical sanctuary sites: the male and female genital tract. Antivir Ther. 2011;16(8):1149-67. PubMed
  4. Läkemedelsstatistik. Stockholm: Socialstyrelsen. 2017 [cited 2018-07-24.] länk

Authors: Mia von Euler, Linnéa Karlsson Lind

Reviewed by: Karin Schenck-Gustafsson

Approved by: Karin Schenck-Gustafsson