Changing from Atripla to Triumeq
Once daily single-tablet regimens (STR) have become an indispensable treatment modality in managing HIV infections. Over the years, they provide many advantages such as improved adherence due to the lower pill burden, health care cost efficiencies, and greater patient satisfaction. As with all existing antiretroviral medications, each drug in combination therapies are assessed for their potential long-term toxicities.
Drug components and indications are updated, and newer agents that are safer and more potent replace outdated drug components. Such is the case for Atripla, the first FDA approved complete STR for HIV-1 infection. While it is still a preferred initial regimen for certain scenarios, it is no longer a first-line treatment. Triumeq is a newer STR with a better safety profile and proven efficacy. Its dolutegravir component has a higher barrier to resistance. Like Atripla, it does not require a booster, so drug-drug interactions are fewer.
Advantages of Triumeq over Atripla
In a 144-week study, Triumeq was found to be superior to Atripla based on different parameters. The participants in the study were treatment-naïve patients with a baseline viral load greater than 100,000c/ml and creatinine clearance greater 50ml/min. The results of the study are as follows:
- Triumeq maintained statistically superior effectiveness vs Atripla. This regimen also demonstrated rapid suppression of the viral load in 28 days versus Atripla’s 84 days. In terms of potency, Triumeq was found to be superior at 48, 96, and 144 weeks.
- Triumeq was more effective than Atripla regardless of viral load. Thirty two percent of the participants had a baseline viral load greater than 100,000c/ml. The drug was able to establish viral suppression among participants with a baseline viral load of lower than 100,000 and greater than 100,000.
- Triumeq has a statistically superior CD4+ T cell count increase than Atripla up to 144 weeks. At the 48th week, there was a 59% difference in response in favor of Triumeq; week 96 and week 144 differences were 44% and 47%, respectively.
- The number of patients who discontinued treatment due to adverse effects were lower with Triumeq versus Atripla. At week 48, only 2% of patients from the Triumeq group had discontinues treatment due to adverse effects, while 10% of patients in the Atripla group experienced side effects that led to discontinuation. At week 144, the discontinuation rate for Triumeq was 4% and 11% for Atripla.
- It was determined that the effect of Triumeq on creatinine level is not clinically significant. Small increases in serum creatinine were reported in the first week of the trial. While this could be a disadvantage of Triumeq, as elevation in serum creatinine is associated with worsening kidney function and the increased risk for adverse outcomes, researchers concluded that this increase is not clinically relevant because the glomerular filtration rates of the patients in the trial were unchanged. Glomerular filtration rate (GFR) is a good indicator of how well your kidneys are working.
- Triumeq demonstrated a higher barrier to resistance. After 144 weeks, NRTI and NNRTI major mutations have been reported for Atripla, but none were reported for Triumeq. At the time of this writing, there are still no resistance mutations reported for Triumeq.
Other safety information
- Atripla is associated with a higher impact on liver chemistry than Triumeq.
- Psychological symptoms (disturbing dreads, depression, anxiety, and suicidal ideation) have been reported with Atripla, possibly due to its efavirenz component.
- The tenofovir part of Atripla may cause kidney and bone toxicities.
- You can switch back to Atripla if Triumeq does not work for you.
- In clinical trials, at least 2% of subjects experience adverse effects such as insomnia and headaches.
- The abacavir part of Atripla may cause serious life-threatening allergic reactions in patients with the HLA-B*5701 allele.
Should you change your current treatment regimen in favor of a new drug with minimal adverse effects and less risk for bone and kidney toxicities? Switching from Atripla to Triumeq may seem like an obvious decision, but you don’t need to rush the switch if your current regimen is well tolerated. Let your doctor assess and discuss the relative benefits and risks of the two regimens with you. Before making an overall assessment, your doctor will consider your condition and the available evidence in support of Triumeq. It is also worth noting that even if you agree with the switch, you still need to test negative for the HLA-B*5701 gene before starting treatment. This genetic allele predicts your risk of developing an allergic reaction to abacavir, one of the drugs included in Triumeq.