Infectivology Xagena

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Genvoya, a single tablet regimen based on Elvitegravir, Cobicistat, Emtricitabine and Tenofovir Alafenamide, for treatment of HIV-1 infection

The FDA ( Food and Drug Administration ) has approved Genvoya ( Elvitegravir 150 mg / Cobicistat 150 mg / Emtricitabine 200 mg / Tenofovir alafenamide 10 mg or E/C/F/TAF ) for the treatment of HIV-1 infection.
Genvoya is the first TAF-based regimen to receive FDA approval.

Genvoya is indicated as a complete regimen for the treatment of HIV-1 infection in adults and pediatric patients 12 years of age and older who have no antiretroviral treatment history or to replace the current antiretroviral regimen in those who are virologically-suppressed ( HIV-1 RNA levels less than 50 copies per mL ) on a stable antiretroviral regimen for at least six months with no history of treatment failure and no known substitutions associated with resistance to the individual components of Genvoya.
No dosage adjustment of Genvoya is required in patients with estimated creatinine clearance greater than or equal to 30 mL per minute.

TAF is a novel targeted prodrug of Tenofovir that has demonstrated high antiviral efficacy similar to and at a dose less than one-tenth that of Gilead’s Viread ( Tenofovir disoproxil fumarate, TDF ), as well as improvement in surrogate laboratory markers of renal and bone safety as compared to TDF in clinical trials in combination with other antiretroviral agents.
Data show that because TAF enters cells, including HIV-infected cells, more efficiently than TDF, it can be given at a lower dose and there is 91% less Tenofovir in the bloodstream.

As the HIV patient population ages there is an increased risk for development of age- and treatment-related comorbidities, including low bone mineral density and renal impairment. This is due to the combination of HIV infection, antiretroviral treatments and the natural aging process.

Genvoya was studied in a phase 3 HIV clinical program in more than 3,500 patients across 21 countries, including treatment-naïve, virologically suppressed, renally impaired and adolescent patients.
The approval is supported by 48-week data from two phase 3 double-blind studies ( Studies 104 and 111 ) among 1,733 treatment-naïve patients in which the regimen met its primary objective of non-inferiority compared to Stribild ( Elvitegravir 150 mg, Cobicistat 150 mg, Emtricitabine 200 mg and Tenofovir disoproxil fumarate 300 mg or E/C/F/TDF ).
In the combined analysis of the studies, 92.4% of Genvoya patients and 90.4% of Stribild patients had HIV-1 RNA levels less than 50 copies/mL at week 48.
Tests of certain renal and bone laboratory parameters also favored Genvoya over Stribild.

Additionally, the approval is supported by a phase 3 study ( Study 109 ) evaluating Genvoya among virologically suppressed patients who switched from TDF-based regimens. The study enrolled 1,436 subjects and 1,196 had reached the 48-week time point at the time of filing.
Among those patients, Genvoya was found to be statistically non-inferior to the TDF-based regimens based on the percentages of patients with HIV-1 RNA levels less than 50 copies/mL at week 48.
Patients receiving Genvoya also demonstrated improvements in certain bone and renal laboratory parameters compared to those treated with the TDF-based regimens.

Finally, data from phase 3 studies evaluating Genvoya among adolescents and patients with mild-to-moderate renal impairment supported the approval.

Genvoya has a boxed warning in its product label regarding the risks of lactic acidosis / severe hepatomegaly with steatosis, and post treatment acute exacerbation of hepatitis B.

Genvoya does not cure HIV infection or AIDS.( Xagena )

Source: Gilead, 2015