Elvitegravir/cobicistat/emtricitabine/tenofovir
Elvitegravir/cobicistat/emtricitabine/tenofovir (brand name Stribild), also known as the Quad pill, is a fixed-dose combination medication for the treatment of HIV/AIDS. Elvitegravir, emtricitabine and tenofovir directly suppress viral reproduction. Cobicistat increases the effectiveness of the combination by inhibiting the liver and gut wall enzymes that metabolize elvitegravir.
| Combination of | |
|---|---|
| Elvitegravir | Integrase inhibitor |
| Cobicistat | Cytochrome P450 inhibitor |
| Emtricitabine | Reverse-transcriptase inhibitor |
| Tenofovir disoproxil | Reverse-transcriptase inhibitor |
| Clinical data | |
| Trade names | Stribild |
| AHFS/Drugs.com | stribild |
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| Routes of administration | Oral |
| ATC code | |
| Legal status | |
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| Identifiers | |
| DrugBank | |
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The drug is manufactured by Gilead Sciences. Elvitegravir/cobicistat/emtricitabine/tenofovir gained approval by the U.S. Food and Drug Administration on August 27, 2012, for use in adults starting antiretroviral treatment for the first time as part of the fixed dose combination. Gilead's stated wholesale price of Stribild is US$28,500 per patient, per year. Gilead maintains that its pricing is comparable to other HIV medications on the market. Elvitegravir/cobicistat/emtricitabine/tenofovir (Stribild) is priced at 39 percent higher than emtricitabine/rilpivirine/tenofovir (Complera), a three-drug HIV regimen approved a year earlier. At the time of Complera's approval, there were concerns about the US$20,500 wholesale cost of efavirenz/emtricitabine/tenofovir (Atripla), which is marketed by Gilead and Bristol-Myers Squibb. HIV drug prices have increased substantially. Atripla, a combination therapy released in 2006, was priced at US$13,800 per person, per year. Atripla's wholesale prices have risen to the level of Complera's at US$20,500. Rising drug costs and HIV cases, combined with tighter state budgets may burden the AIDS Drug Assistance Program (ADAP) to the breaking point. Kaiser Family Foundation reports that ADAP provided HIV drug benefit to 138,000 people in 2011, with a waiting list totaling 2,030 HIV-positive individuals. Many states including California, Colorado, Georgia, and Virginia are considering measures to cut ADAP spending.
An increase in the serum creatinine level (a marker of kidney function) may increase with use of Elvitegravir/cobicistat/emtricitabine/tenofovir. This is caused by inhibition of tubular secretion of creatinine in the nephron by cobicistat. An increase of up to 0.3 mg/dL is expected; if serum creatinine level increases by 0.4 mg/dL or more, further evaluation for other causes of acute kidney injury is recommended.
See also
- Genvoya, a similar drug combination but with tenofovir alafenamide instead of tenofovir disoproxil
References
External links
- "Cobicistat mixture with elvitegravir, emtricitabine and tenofovir disoproxil fumarate". Drug Information Portal. U.S. National Library of Medicine.