December #184 : Stribild is Here - by Tim Horn

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December 2012

Stribild is Here

by Tim Horn

Who comes up with these names, anyway? Formerly known as the Quad, the single-tablet regimen Stribild (pronounced STRY-build) was approved in late August and landed on pharmacy shelves soon thereafter.

Stribild contains three drugs active against HIV: the new integrase inhibitor elvitegravir and the tried-and-true backbone nukes tenofovir and emtricitabine. The tablet also contains cobicistat, a novel pharmacokinetic (PK) enhancer needed to boost blood levels of elvitegravir. U.S. HIV treatment guidelines rank Stribild as an “alternative” option for first-time treatment takers.

“This is a one-pill, once daily treatment option that has fewer central nervous system and rash side effects, compared with Atripla,” says Paul Sax, MD, of Brigham and Women’s Hospital in Boston, though he adds that nausea is still an issue and Stribild is probably best avoided by those with kidney disease. “Responses were every bit as good as Atripla in one study and as Norvir-boosted Reyataz plus Truvada in another.”

Some docs, however, question where Stribild fits in the HIV treatment toolbox. “What’s better about [Stribild] compared to what we have?” asks Howard Grossman, MD, a private physician with AlphaBetterCare in New York. “It doesn’t have superior action, I’m not aware of any resistance advantage, and it’s far more expensive.”

As pricey as it may be—it costs 35 percent more than Atripla—the good news is that assistance is available: Reduced pricing for ADAP has already been solidified, and both co-pay and patient assistance programs are available from Gilead, Stribild’s manufacturer.

Search: Stribild, Quad, tenofovir, emtricitabine, elvitegravir, cobicistat, Paul Sax, Howard Grossman, Gilead

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