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Triumeq vs Biktarvy
Introduction
For patients with human immunodeficiency virus (HIV) infection, certain antiretroviral drugs can assist in controlling the virus and preventing it from progressing to acquired immune deficiency syndrome (AIDS). Triumeq and Biktarvy are two such combination medicines used to treat HIV. Both medications contain a blend of different antivirals that interfere with enzymes needed by HIV for replication, thereby slowing the growth of the virus in the patient's body.
Triumeq combines dolutegravir, an integrase inhibitor; abacavir, a nucleoside reverse transcriptase inhibitor (NRTI); and lamivudine also an NRTI. These work together to inhibit viral replication at multiple stages within the life cycle of HIV.
Biktarvy on its part combines bictegravir, an integrase inhibitor; emtricitabine and tenofovir alafenamide both NRTIs. Like in Triumeq these three drugs target various stages of HIV's lifecycle but they have slightly different pharmacokinetics which may affect tolerability or drug-drug interactions.
Triumeq vs Biktarvy Side By Side
| Attribute | Triumeq | Biktarvy |
|---|---|---|
| Brand Name | Triumeq | Biktarvy |
| Contraindications | Cannot be taken if you have a certain genetic issue (variant of the gene HLA-B*5701), or if taking rifampicin-based drugs for tuberculosis and St John's wort among others. | Cannot be taken if taking rifampicin-based drugs for tuberculosis and St John's wort among others. Hepatitis B infection needs to be monitored closely. |
| Cost | $3000 for 30 tablets | $3100 for 30 tablets |
| Generic Name | Dolutegravir, Abacavir, and Lamivudine | Bictegravir, Emtricitabine, and Tenofovir Alafenamide |
| Most Serious Side Effect | Increased risk of immune system changes (Immune Reconstitution Syndrome), symptoms of lactic acidosis, signs of liver problems, allergic reactions, changes in body fat distribution | Signs of a hypersensitive reaction, unusual changes in mood or behavior, liver problems, kidney problems, lactic acidosis symptoms |
| Severe Drug Interactions | Rifampicin-based drugs for tuberculosis, St John's wort | Rifampicin-based drugs for tuberculosis, St John's wort |
| Typical Dose | One tablet per day for adults and children who weigh at least 40 kg (88 lbs) | One tablet daily, containing 50 mg of bictegravir, 200 mg of emtricitabine, and 25 mg of tenofovir alafenamide |
What is Triumeq?
Triumeq and Biktarvy are both antiretroviral medications used in the treatment of human immunodeficiency virus (HIV). Triumeq, a combination of dolutegravir, abacavir, and lamivudine, was approved by FDA in 2014. It works by inhibiting the replication of HIV cells thus slowing down the progression of the disease. However, for it to be effective, patients must have no history or risk factors for heart disease due to abacavir's potential cardio-toxicity.
On the other hand, Biktarvy is an amalgamation of bictegravir emtricitabine, and tenofovir alafenamide that was approved more recently in 2018. The medication has proven effective as it stops two enzymes - reverse transcriptase and integrase - essential for HIV replication. Its advantage over Triumeq lies in its safety profile; unlike Triumeq’s abacavir component which can cause serious side effects like heart attacks especially if you have certain risk factors such as smoking or older age; there are fewer risks associated with Biktarvy's ingredients making it a safer choice for a wider range of patients.
What conditions is Triumeq approved to treat?
Triumeq is approved for the treatment of human immunodeficiency virus (HIV) infection:
- Used as a complete regimen or in conjunction with other antiretroviral drugs
- Can be used in adults and children who weigh at least 40 kilograms (88 pounds)
- It's also prescribed for individuals who are treatment-naive or those whose HIV-infection has been stabilized and managed on certain specific regimens
How does Triumeq help with these illnesses?
Triumeq aids in the management of HIV (Human Immunodeficiency Virus) by increasing the number of healthy white blood cells (CD4 cells) in the body. It achieves this by blocking an enzyme called integrase that HIV uses to infect and destroy these immune system cells, so levels can be maintained higher for longer periods of time. CD4 cells are a type of lymphocyte, a white blood cell that plays an important role in protecting our bodies from infection and disease. In people with HIV, the virus attacks and kills these CD4 cells, weakening their immune system over time. Therefore, by inhibiting integrase, Triumeq helps limit the destructive effects of HIV on patients' immune systems and assists them in managing their condition more effectively.
Similarly to Triumeq, Biktarvy is also utilized for treating HIV infections. This medication works by preventing two different enzymes used by the virus from functioning properly – reverse transcriptase and integrase – thereby hindering its ability to multiply within your body's defense mechanism or attack new healthy CD4+ T-cells.
What is Biktarvy?
Biktarvy is a brand name for a combination of three antiretroviral drugs: bictegravir, emtricitabine, and tenofovir alafenamide. This powerful trio is designed to prevent HIV from multiplying in the body by blocking certain enzymes crucial to the virus's growth - specifically, an enzyme called integrase. Biktarvy was first approved by the FDA in 2018. As it contains bictegravir, which is not included in Triumeq (a combination of abacavir, dolutegravir, and lamivudine), there are differences between these two treatments. The presence of this additional drug means that its side-effect profile may differ from that of Triumeq; notably fewer hypersensitivity reactions compared to abacavir-containing regimens like Triumeq and less likelihood to cause weight gain or affect kidney function negatively than some other antiretroviral drugs (common concerns with HIV medications). The effects on preventing HIV replication can be beneficial for patients who have not responded well to other "typical" antiretroviral therapies.
What conditions is Biktarvy approved to treat?
Biktarvy is a highly effective antiretroviral medication approved for the treatment of:
- HIV-1 infection in adults who have no prior antiretroviral treatment history
- HIV-1 infection in adults whose virus is currently suppressed due to stable antiretroviral therapy for at least 3 months with no history of treatment failure. This combination pill reduces the number of medicines a person needs to take daily, making it easier for individuals to stick with their medication regimen.
How does Biktarvy help with these illnesses?
Biktarvy is a highly efficacious antiretroviral medication used in the treatment of HIV. It contains three active ingredients: bictegravir, emtricitabine, and tenofovir alafenamide. Bictegravir inhibits the action of integrase, an enzyme HIV needs to multiply inside cells. Emtricitabine and tenofovir are both nucleoside reverse transcriptase inhibitors (NRTIs) that block another enzyme HIV requires for replication.
Biktarvy works by reducing the amount of virus in your body, helping your immune system to recover and decrease complications associated with HIV infection. Compared to Triumeq, which also has three active ingredients but uses dolutegravir as its integrase inhibitor instead of bictegravir, Biktarvy offers comparable efficacy but a superior resistance profile because it's less likely for the virus to develop resistance against it over time or due to missed doses. Therefore, if patients have issues adhering strictly to their regimen schedule or happenings outside their control lead them missing doses occasionally — Biktarvey could be a more suitable choice.
How effective are both Triumeq and Biktarvy?
Both Triumeq and Biktarvy are highly effective antiretroviral medications used in the treatment of HIV, with their approval by the FDA only a few years apart. Each medication contains different active substances; hence, they may be chosen based on individual patient's circumstances. A 2017 clinical trial compared Triumeq to another drug regimen that included components found in Biktarvy; both treatments demonstrated similar ability to inhibit viral replication and maintain low levels of virus in patients' bloodstreams - key goals for managing HIV.
A 2018 review highlighted that Triumeq was effective at suppressing viral loads from the first month of treatment onwards. It also pointed out its favorable side effect profile over many other antiretrovirals, making it well-tolerated even among populations such as pregnant women or individuals co-infected with hepatitis B/C viruses. Furthermore, among clinicians worldwide, this combination therapy quickly became a preferred choice due to its efficacy and tolerability.
On the other hand, a 2020 meta-analysis indicated that Biktarvy appears just as potent as any existing antiretroviral therapies while offering an improved safety profile — particularly regarding bone mineral density and kidney function — two commonly affected areas with long-term antiretroviral use. Even though Biktarvy is generally considered after other first-line treatments due to its recent introduction into clinical practice relative to older therapies like those contained within Triumeq, significant research has shown it is safe and efficacious when taken alone or alongside additional therapies for patients who did not respond optimally to initial treatments. Thus far however, further studies are needed confirm whether one might significantly augment beneficial effects when paired with others.
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At what dose is Triumeq typically prescribed?
Oral dosages of Triumeq for treating HIV-1 infection in adults and children who weigh at least 40 kg (88 lbs) is one tablet per day. It's important to note that this medication should not be used by individuals with a certain genetic issue (a variant of the gene HLA-B*5701). On the other hand, Biktarvy is also taken orally once a day for the treatment of HIV-1 infection in adults and pediatric patients weighing at least 25 kg (55 lbs). Neither Triumeq nor Biktarvy should be adjusted or increased after few weeks if there is no response as it might increase side effects. Always follow your doctor's instructions when taking these medications.
At what dose is Biktarvy typically prescribed?
Biktarvy treatment is typically initiated with a daily dosage of one tablet, which contains 50 mg of bictegravir, 200 mg of emtricitabine and 25 mg of tenofovir alafenamide. The dose remains constant; there's no need for an increase over time. It can be taken with or without food at any time during the day but it is important to maintain consistency in order to keep drug levels stable in your system. If after a few weeks you do not see an improvement in your HIV viral load count or if side effects become intolerable, consult your doctor immediately as adjustment or change in medication may be necessary.
What are the most common side effects for Triumeq?
The most common side effects associated with Triumeq include:
- Insomnia
- Headache
- Fatigue (general weakness and tiredness)
- Hypersensitivity reactions (rash, fever, nausea)
- Nausea and vomiting
- Diarrhea
- Increased liver enzymes
- Abdominal pain or discomfort
- Changes in the shape or location of body fat
Common adverse effects linked to Biktarvy are:
- Diarrhea
- Nausea
- Headache
- Fatigue
- Abnormal dreams
- Rash, itching or hives on the skin
Note that these lists are not exhaustive. If you experience any other symptoms while taking either of these medications, consult your healthcare provider immediately.
Are there any potential serious side effects for Triumeq?
While both Triumeq and Biktarvy are generally well-tolerated, there can be potential side effects with each. Severe complications may occur in rare cases such as:
- Increased risk of immune system changes (Immune Reconstitution Syndrome)
- Symptoms of lactic acidosis like muscle pain or weakness; numbness or cold feeling in your arms and legs; trouble breathing; stomach pain, nausea with vomiting; fast or uneven heart rate
- Signs of liver problems: upper stomach pain, loss of appetite, dark urine coloration, jaundice (yellowing of the skin or eyes), clay-colored stools
- Allergic reactions: hives, difficulty breathing due to throat swelling; fever coupled with a burning sensation in the eyes leading to skin peeling
- Changes in body fat distribution
If you experience any such symptoms while taking either medication contact your healthcare professional promptly. Always remember that it is important not to alter your HIV treatment without discussing it first with your doctor.
What are the most common side effects for Biktarvy?
Some side effects commonly associated with Biktarvy include:
- Nausea, diarrhea
- Headache or dizziness
- Changes in the shape or location of body fat (especially in your arms, legs, face, neck, breasts)
- Increased cholesterol and triglycerides levels
- Immune system changes Please note that this isn't a comprehensive list of potential side effects. It's also worth noting that everyone reacts differently to medications - while some people might experience these symptoms when taking Biktarvy, others may not have any issues at all.
Are there any potential serious side effects for Biktarvy?
While Biktarvy is generally well-tolerated, it can occasionally cause severe side effects. Be vigilant for:
- Signs of a hypersensitive reaction: rash, hives, itching, trouble breathing or swallowing, swelling in your face or throat
- Unusual changes in mood or behavior and/or signs of depression
- Liver problems signaled by yellowing of the skin and eyes (jaundice), dark-colored urine, light-colored stools, nausea or vomiting and loss of appetite
- Kidney problems exhibited through changes in urination frequency; increased thirst; muscle pain or weakness; bone pain; thinning hair
- Lactic acidosis symptoms such as unusual muscle pain/tenderness/weakness (especially if accompanied by fatigue or fever), difficulty breathing and stomach pain with nausea/vomiting. If you observe any of these symptoms while taking Biktarvy contact your healthcare provider immediately.
Contraindications for Triumeq and Biktarvy?
Both Triumeq and Biktarvy, along with most other antiretroviral medications, may cause side effects like fatigue, nausea or insomnia in some people. If you experience worsening of these symptoms or any new ones such as jaundice (yellowing of the skin or eyes), unexplained weight loss, dark urine or abdominal pain, please seek immediate medical attention.
Neither Triumeq nor Biktarvy can be taken if you are taking certain medications including rifampicin-based drugs for tuberculosis and St John's wort among others. Always inform your physician about all the medications you are currently taking; these medicines can potentially interact negatively with either Triumeq or Biktarvy. Certain conditions like hepatitis B infection need to be monitored closely when one is on treatment with either of these two drugs due to a risk of exacerbation after discontinuation.
How much do Triumeq and Biktarvy cost?
For the brand name versions of these drugs:
- The price of 30 tablets of Triumeq averages around $3000, which works out to approximately $100/day.
- The price for a monthly supply (30 tablets) of Biktarvy is about the same at around $3100 per month, working out to roughly $103/day.
Thus, if you are on either medication for HIV treatment, both antiretroviral therapies will cost nearly the same on a daily basis. Please note that cost should not be a primary consideration in determining which of these drugs is right for you since their effectiveness and side effect profiles differ.
As for generic versions - currently there are no approved generics available in the United States or Canada for Triumeq and Biktarvy due to patent protections. Thus patients must rely on brand name versions until those patents expire.
Popularity of Triumeq and Biktarvy
Triumeq and Biktarvy are two highly effective antiretroviral medications used in the treatment of HIV.
In 2020, Triumeq was prescribed to approximately 670,000 people in the US. This accounted for nearly 20% of prescriptions for single-tablet regimens (STRs) for HIV treatment. Despite being a newer medication on the market, it has seen an increase in use due to its efficacy and tolerability since its introduction in 2014.
On the other hand, Biktarvy quickly gained popularity since its approval by FDA in February 2018. By the end of 2020, it was estimated that over one million people were taking this medication. This rapid adoption made Biktarvy account for just under a third of STR prescriptions within only three years after release - a testament to both its effectiveness and excellent side-effect profile.
Conclusion
Both Triumeq and Biktarvy have been widely used in the treatment of HIV-1 infection, with numerous clinical studies validating their effectiveness over placebo treatments. In some cases, these medication regimens may be combined or switched depending on the patient's needs and virus resistance profile; however, this requires careful oversight from a physician due to potential drug-drug interactions. The choice between these two depends largely on their differing components: Triumeq contains abacavir, dolutegravir, and lamivudine while Biktarvy combines bictegravir with emtricitabine and tenofovir alafenamide.
Triumeq is often considered as a first-line treatment option for patients who are HLA-B*5701 negative (to minimize hypersensitivity reactions), whereas Biktarvy might be chosen for its high potency, lower risk of side effects like kidney toxicity or bone density loss because it carries tenofovir alafenamide instead of tenofovir disoproxil fumarate which is present in many other antiretroviral combinations.
Both drugs are available in generic form offering cost savings particularly beneficial for out-of-pocket payers. Both Triumeq and Biktarvy also require an adjustment period where benefits may not be immediately noticeable.
The side effect profiles are somewhat similar - generally well-tolerated but varying based on individual response. For both medications, patients must monitor their health closely when initiating therapy since severe immune reconstitution inflammatory syndrome (IRIS) can occur during early stages of treatment. Always consult your healthcare provider promptly if you experience any worsening symptoms or new onset illnesses after starting antiretroviral therapy.
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Refrences
- Markham, A. (2018, March 21). Bictegravir: First Global Approval. Drugs. Springer Science and Business Media LLC.http://doi.org/10.1007/s40265-018-0896-4
- Rigo-Bonnin, R., Tiraboschi, J. M., Álvarez-Álvarez, M., Pérez-Fernández, G. A., Sanjuás-Iglesias, M., Scévola, S., … Podzamczer, D. (2020, June). Measurement of total and unbound bictegravir concentrations in plasma and cerebrospinal fluid by UHPLC-MS/MS. Journal of Pharmaceutical and Biomedical Analysis. Elsevier BV.http://doi.org/10.1016/j.jpba.2020.113250
- Wohl, D. A., Yazdanpanah, Y., Baumgarten, A., Clarke, A., Thompson, M. A., Brinson, C., … Martin, H. (2019, June). Bictegravir combined with emtricitabine and tenofovir alafenamide versus dolutegravir, abacavir, and lamivudine for initial treatment of HIV-1 infection: week 96 results from a randomised, double-blind, multicentre, phase 3, non-inferiority trial. The Lancet HIV. Elsevier BV.http://doi.org/10.1016/s2352-3018(19)30077-3