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New drugs for first-line treatment?
Aug 4, 2003

Hello,

Can you comment on the two most recently approved drugs - atazanavir and emtricitabine - and their implications for first-line treatment? I don't need treatment yet but am collecting information in advance and would appreciate your comments.

Thanks for all your good work.

Response from Dr. Young

Both atazanavir (Reyataz) and emtricitabine (Emtriva) will likely have some impact on first-line therapy.

Atazanavir is a once-daily, low pill count (2 daily) protease inhibitor with a very acceptable side effect profile-- it is easy to see how this might be incorporated into a first line regimen. A large clinical trial compared taz to efavirenz (Sustiva), showing comparable results. Because the newest recommendations speak to using boosted PIs first, it's not clear how this statement will affect things, but since in a salvage clinical trial, unboosted atazanavir under-performed compared to lopinavir/ritonavir (Kaletra), it is probably safe to say that the same applies to first-line use.

Emtricitabine (Emtriva) is a structural cousin to the popular drug lamivudine (Epivir, a component in Combivir and Trizivir). There are very little differences between the two drugs, and it is very likely that the drug will eventually find it's way into a co-formulation with Gilead's other HIV drug, tenofovir (Viread). Because of the similarity between the two drugs and the huge popularity of lamivudine in first-line therapies, it is likely that the newer drug, with support of large clinical studies, may take a portion of the lamivudine marketplace, particularly if combined into a single tablet with tenofovir. BY



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