PIFELTRO™ (doravirine 100 mg) tablets and DELSTRIGO™ (doravirine 100 mg/lamivudine 300 mg/tenofovir disoproxil fumarate 300 mg) tablets

 

Rates of Discontinuation & Common Adverse Events

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Adverse reactions and laboratory abnormalities in virologically suppressed adults

Adverse reactions

Overall, the safety profile in virologically suppressed adult subjects was similar to that in subjects with no antiretroviral treatment history.

Common adverse events in DRIVE-AHEAD

Laboratory abnormalities

Serum ALT and AST Elevations: In the DRIVE-SHIFT trial, 22% and 16% of subjects in the immediate switch group experienced ALT and AST elevations greater than 1.25 X ULN, respectively, through 48 weeks on DELSTRIGO. For these ALT and AST elevations, no apparent patterns with regard to time to onset relative to switch were observed. One percent of subjects had ALT or AST elevations greater than 5 X ULN through 48 weeks on DELSTRIGO.

The ALT and AST elevations were generally asymptomatic, and not associated with bilirubin elevations. In comparison, 4% and 4% of subjects in the delayed switch group experienced ALT and AST elevations of greater than 1.25 X ULN, respectively, through 24 weeks on their baseline regimen.

View study design

Rates of discontinuation due to adverse events in treatment-naïve adults

In treatment-naïve adults, doravirine demonstrated a:

Low rate of discontinuation due to adverse events

DRIVE-AHEAD: Rate of discontinuation at Week 96
3% DELSTRIGO
once daily (n=364)
vs 7% EFV/FTC/TDF
once daily (n=364)
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Common adverse reactions in treatment-naïve adults

No adverse reactions Grade 2 or higher (moderate to severe) occurred in ≥2% of patients taking DELSTRIGO

Adverse reactions of all grades reported in ≥5% of patients in any treatment group

DRIVE-AHEAD
DELSTRIGO

(once daily n=364)

EFV/FTC/TDF

(once daily n=364)

Dizziness 7% 32%
Nausea 5% 7%
Abnormal Dreams 5% 10%
Headache 4% 5%
Insomnia 4% 5%
Diarrhea 4% 6%
Somnolence 3% 7%
Rasha 2% 12%

(a) Includes rash, rash erythematous, rash generalized, rash macular, rash maculo-papular, rash papular, rash pruritic, and rash pustular.

A randomized, international, multicenter, open-label trial to assess efficacy and safety of switching to DELSTRIGO

DRIVE-SHIFT Clinical Trial for DELSTRIGO™ (doravirine/lamivudine/tenofovir disoproxil fumarate)

670 adult subjects with virologically suppressed HIV-1 for ≥6 months on 2 NRTIs with a PI plus either ritonavir or cobicistat, or elvitegravir plus cobicistat, or an NNRTI were randomized to either:

Immediate Switch Group:

  • Participants were immediately switched to DELSTRIGO on Day 1 of the study for 48 weeks (n=447)

Delayed Switch Group:

  • Participants continued on their baseline regimen. At the 24-week time point, participants were switched to DELSTRIGO for 24 weeks (n=223)

Efficacy

  • Primary efficacy outcome: The proportion of participants with HIV-1 RNA <50 copies/mL at Week 48 in the immediate switch group compared to Week 24 in the delayed switch group1
Delstrigo_new_adverse

Safety

  • For participants whose baseline regimen included a PI plus ritonavir: change from baseline in fasting LDL-C and fasting non-HDL-C at Week 24 in both treatment groups1

DELSTRIGO was studied in a phase 3, randomized, international, multicenter, double-blind, active-controlled trial


728 adult treatment-naïve subjects with HIV-1 were randomized 1:1 and received a once-daily dose of either DELSTRIGO or EFV/FTC/TDF for 96 weeks to assess efficacy and safety.

delstrigoTolerabilityImg

Primary end points

  • The proportion of participants who had plasma HIV-1 RNA <50 copies/mL at Week 482
  • Proportion of participants with three pre-specified neuropsychiatric events (dizziness, sleep disorders/disturbances, altered sensorium)2

Secondary safety end point

  • Change from baseline in fasting LDL-C and non-HDL-C2

Definitions

  • ALT = alanine aminotransferase
  • ARV = antiretroviral
  • AST = aspartate aminotransferase
  • EFV = efavirenz
  • FTC = emtricitabine
  • HDL-C = high-density lipoprotein cholesterol
  • HIV-1 = human immunodeficiency virus type 1
  • LDL-C = low-density lipoprotein cholesterol
  • NNRTI = non-nucleoside reverse transcriptase inhibitor
  • NRTI = nucleoside reverse transcriptase inhibitor
  • PI = protease inhibitor
  • RNA = ribonucleic acid
  • TDF = tenofovir disoproxil fumarate
  • ULN = upper limit of normal range

References

  • 1. Johnson M, Kumar P, Molina JM, et al; for the DRIVE-SHIFT Study Group. Switching to doravirine/lamivudine/tenofovir disoproxil fumarate (DOR/3TC/TDF) maintains HIV-1 virologic suppression through 48 weeks: results of the DRIVE-SHIFT trial. J Acquir Immune Defic Syndr. 2019;81(4):463-472. doi:10.1097/QAI.0000000000002056.
  • 2. Orkin C, Squires KE, Molina JM, et al; for the DRIVE-AHEAD Study Group. Doravirine/lamivudine/tenofovir disoproxil fumarate is non-inferior to efavirenz/emtricitabine/tenofovir disoproxil fumarate in treatment-naive adults with human immunodeficiency virus-1 infection: week 48 results of the DRIVE-AHEAD trial. Clin Infect Dis. 2019;68(4):535-544.
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Indications

Indications for PIFELTRO and DELSTRIGO:

PIFELTRO is indicated in combination with other antiretroviral (ARV) agents for the treatment of HIV-1 infection in adult patients with no prior ARV treatment history or to replace the current ARV regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to doravirine.

DELSTRIGO is indicated as a complete regimen for the treatment of HIV-1 infection in adult patients with no prior ARV treatment history or to replace the current ARV regimen in those who are virologically suppressed (HIV-1 RNA less than 50 copies per mL) on a stable ARV regimen with no history of treatment failure and no known substitutions associated with resistance to the individual components of DELSTRIGO.

US-DOR-00197 02/20

Selected Safety Information

Warning: Posttreatment Acute Exacerbation of Hepatitis B (HBV)

All patients with HIV-1 should be tested for the presence of HBV before initiating ARV therapy. Severe acute exacerbations of HBV have been reported in patients who are coinfected with HIV-1 and HBV and have discontinued products containing lamivudine or tenofovir disoproxil fumarate (TDF), which are components of DELSTRIGO. Patients coinfected with HIV-1 and HBV who discontinue DELSTRIGO should be monitored with both clinical and laboratory follow-up for at least several months after stopping DELSTRIGO. If appropriate, initiation of anti-HBV therapy may be warranted.

  • PIFELTRO and DELSTRIGO are contraindicated when co-administered with drugs that are strong cytochrome P450 (CYP)3A enzyme inducers (including the anticonvulsants carbamazepine, oxcarbazepine, phenobarbital, and phenytoin; the androgen receptor inhibitor enzalutamide; the antimycobacterials rifampin and rifapentine; the cytotoxic agent mitotane; and the herbal product St. John’s wort (Hypericum perforatum)), as significant decreases in doravirine plasma concentrations may occur, which may decrease the effectiveness of DELSTRIGO and PIFELTRO.
  • DELSTRIGO is contraindicated in patients with a previous hypersensitivity reaction to lamivudine.
  • Renal impairment, including cases of acute renal failure and Fanconi syndrome, have been reported with the use of TDF. DELSTRIGO should be avoided with concurrent or recent use of a nephrotoxic agent (eg, high-dose or multiple NSAIDs). Cases of acute renal failure after initiation of high-dose or multiple NSAIDs have been reported in patients with risk factors for renal dysfunction who appeared stable on TDF.
  • Prior to or when initiating DELSTRIGO, and during treatment, assess serum creatinine, estimated creatinine clearance, urine glucose, and urine protein in all patients. In patients with chronic kidney disease, also assess serum phosphorus. Discontinue DELSTRIGO in patients who develop clinically significant decreases in renal function or evidence of Fanconi syndrome. Discontinue DELSTRIGO if estimated creatinine clearance declines below 50 mL/min.
  • In clinical trials in HIV-1 infected adults, TDF was associated with slightly greater decreases in bone mineral density (BMD) and increases in biochemical markers of bone metabolism. Serum parathyroid hormone levels and 1,25 Vitamin D levels were also higher. Cases of osteomalacia associated with proximal renal tubulopathy have been reported with the use of TDF.
  • Immune reconstitution syndrome can occur, including the occurrence of autoimmune disorders with variable time to onset, which may necessitate further evaluation and treatment.
  • Because DELSTRIGO is a complete regimen, co-administration with other antiretroviral medications for the treatment of HIV-1 infection is not recommended.
  • Co-administration of PIFELTRO with efavirenz, etravirine, or nevirapine is not recommended.
  • If DELSTRIGO is co-administered with rifabutin, take one tablet of DELSTRIGO once daily, followed by one tablet of doravirine (PIFELTRO) approximately 12 hours after the dose of DELSTRIGO.
  • If PIFELTRO is co-administered with rifabutin, increase PIFELTRO dosage to one tablet twice daily (approximately 12 hours apart).
  • Consult the full Prescribing Information prior to and during treatment for more information on potential drug-drug interactions.
  • Because DELSTRIGO is a fixed-dose combination tablet and the dosage of lamivudine and TDF cannot be adjusted, DELSTRIGO is not recommended in patients with estimated creatinine clearance less than 50 mL/min.
  • The most common adverse reactions with DELSTRIGO (incidence ≥5%, all intensities) were dizziness (7%), nausea (5%), and abnormal dreams (5%). The most common adverse reactions with PIFELTRO (incidence ≥5%, all intensities) were nausea (7%), dizziness (7%), headache (6%), fatigue (6%), diarrhea (6%), abdominal pain (5%), and abnormal dreams (5%).
  • The safety of DELSTRIGO in virologically-suppressed adults was based on Week 48 data from subjects in the DRIVE-SHIFT trial. Overall, the safety profile in virologically-suppressed adult subjects was similar to that in subjects with no ARV treatment history.
  • Serum ALT and AST Elevations: In the DRIVE-SHIFT trial, 22% and 16% of subjects in the immediate switch group experienced ALT and AST elevations greater than 1.25 X ULN, respectively, through 48 weeks on DELSTRIGO. For these ALT and AST elevations, no apparent patterns with regard to time to onset relative to switch were observed. One percent of subjects had ALT or AST elevations greater than 5 X ULN through 48 weeks on DELSTRIGO. The ALT and AST elevations were generally asymptomatic, and not associated with bilirubin elevations. In comparison, 4% and 4% of subjects in the delayed switch group experienced ALT and AST elevations of greater than 1.25 X ULN through 24 weeks on their baseline regimen.
  • There is a pregnancy exposure registry that monitors pregnancy outcomes in individuals exposed to PIFELTRO or DELSTRIGO during pregnancy. Healthcare providers are encouraged to register patients by calling the Antiretroviral Pregnancy Registry (APR) at 1-800-258-4263.
  • Mothers infected with HIV-1 should be instructed not to breastfeed if they are receiving PIFELTRO or DELSTRIGO due to the potential for HIV-1 transmission.

Before prescribing PIFELTRO, please read the accompanying Prescribing Information. The Patient Information also is available. Before prescribing DELSTRIGO, please read the accompanying Prescribing Information, including the Boxed Warning about posttreatment acute exacerbation of Hepatitis B. The Patient Information also is available.

US-DOR-0061104/20