What is it and what is it used for?
Genvoya is an antiviral medicine used to treat individuals infected with human immunodeficiency virus type 1 (HIV-1), a virus that causes acquired immune deficiency syndrome (AIDS). It is used in adults and adolescents aged over 12 years whose disease is not expected to be resistant to any of the antiviral substances in Genvoya.
Genvoya contains the active substances elvitegravir, cobicistat, emtricitabine and tenofovir alafenamide.
How Genvoya works
Genvoya contains four active substances. Elvitegravir is a type of antiviral agent called an ‘integrase inhibitor’. By blocking an enzyme called integrase, elvitegravir stops the virus’s genetic material from integrating into the genetic material of the cells it has infected. This reduces the virus’s ability to replicate and slows down the spread of infection. Cobicistat increases the level of elvitegravir by slowing its breakdown. This boosts elvitegravir’s antiviral effect.
Tenofovir alafenamide is a ‘prodrug’ of tenofovir, meaning that it is converted into the active substance tenofovir in the body. Tenofovir and emtricitabine are related antiviral agents called reverse transcriptase inhibitors. They block the activity of reverse transcriptase, a virus enzyme that allows HIV-1 to replicate in the cells it has infected. By blocking reverse transcriptase, Genvoya reduces the amount of HIV-1 in the blood and keeps it at a low level.
Genvoya does not cure HIV-1 infection or AIDS, but it may delay the damage to the immune system and the development of infections and diseases associated with AIDS.
How Genvoya is used
The medicine can only be obtained with a prescription and treatment should be started by a doctor who is experienced in managing HIV infection. Genvoya is available as tablets, each containing 150 mg elvitegravir, 150 mg cobicistat, 200 mg emtricitabine and 10 mg tenofovir alafenamide. The recommended dose is one tablet a day, taken with food.
Product information changes
The product information has been updated to advise not to initiate this product during pregnancy, and to switch to alternative regimen for pregnant women. This is based on data from a study which showed that there was lower elvitegravir and cobicistat levels during 2nd and 3rd trimesters compared to after birth. This means that the treatment may be less effective.
What are the benefits?
The European Medicines Agency decided that Genvoya’s benefits are greater than its risks and recommended that it be approved for use in the EU. Three of the active substances, elvitegravir, cobicistat and emtricitabine have already been shown to be effective. The fourth, tenofovir alafenamide, is effective at a lower dose than the established medicine tenofovir disoproxil and offers the possibility of reduced side effects.
In studies, the effectiveness of Genvoya was high and comparable to that of a medicine containing elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil. Genvoya’s side effects were similar to those of the individual medicines. Tenofovir alafenamide had a milder effect on the kidney than tenofovir disoproxil. The Agency also considered that combining the medicines in a single tablet simplifies treatment.
What are main side effects?
The most common side effect with Genvoya (which may affect more than 1 in 10 people) is nausea (feeling sick). Other side effects include abnormal dreams, dizziness, feeling tired, and diarrhoea.
For the full list of all side effects reported with Genvoya, see the package leaflet.
Genvoya must not be taken with certain other medicines because of the possibility of harmful interactions. For the full list of restrictions, see the package leaflet.
What studies have been done?
Genvoya was investigated in two main studies involving 1,733 adults infected with HIV-1 who had not been treated previously. In both studies, Genvoya was compared with another antiviral medicine which contained the active ingredients elvitegravir, cobicistat, emtricitabine and tenofovir disoproxil. The main measure of effectiveness was based on the reduction of the amount of HIV-1 in the blood. The infection was considered to have responded to treatment if the viral load in the patient’s blood was less than 50 of HIV-1 RNA copies/ml.
After 48 weeks around 90% of patients treated with both Genvoya (800 of 866 patients) and the comparator (784 of 867 patients) had responded to treatment.
In a supporting study, patients who were being treated with effective HIV treatment either continued with the same treatment or were switched to Genvoya. After 48 weeks a viral load of less than 50 copies/ml was seen in 97% (932 of 959) of patients switched to Genvoya and 93% (444 of 477) of patients who continued with their usual treatment.
In another study, Genvoya was given to adolescents aged 12 to 18 years with HIV-1 infection who had not been treated previously. The viral load was reduced to less than 50 copies/ml after 24 weeks in 90% (45 of 50) of patients.
EMA website for Genvoya.
Accessed on 01/11/17.
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