Gilead Sciences of Foster City, CA, the pharmaceutical leader in HIV research and care, has plans for a new one pill per day HIV treatment, to compete with Atripla. Gilead currently co-markets Atripla with Bristol-Myers Squibb, and it is a leading HIV medication particularly for first-line patients. Atripla itself is composed of three drugs, two from Gilead and one from Bristol Myers. While very effective and popular, one of the drugs it contains sustiva which can cause side effects ranging from vivid dreams, nightmares to severe depression and dizziness in a non-trivial minority of patients.
The new combination pill, as yet un-named, will contain the two drug components of Atripla – emtriva and viread – which are from Gilead, but rather than the Sustiva (which is Bristol Myers contribution) Gilead is developing a new Integrase inhibitor, elvitegravir, as well as a drug they hope will replace Abbott Labs ritonavir as a booster. While containing four drugs, Gilead has indicated the pill will be smaller than Atripla.
The new elvitigravir is already in clinical trials. The new booster drug is not as far along, but activists hope it may break the stranglehold which Abbott Labs now has with ritonavir. Overall the new combo pill is several years away if it passes trials.
Abbott has used their monopoly to jack up the price of ritonovir four-fold a few years ago when its efficacy in boosting the blood levels of other HIV drigs was discovered. Abbott bundles it at no cost with its own drug lopinivir which combination it markets as Kaletra.
Kaletra has been superseded by newer PIs with even fewer side effects including Reyataz and Prezista. These drugs must be used in combination with ritonavir, so Abbott uses their lock on ritonavir to get a chunk of those markets. At patient expense, of course. As well, ritonavir is a liquid and so prevents it from being part of a one-pill combo treatment. Gileads’ new booster is a solid.
The other good news about the combo pill is that it will be based on an Integrase inhibitor, a new class of drugs, which makes it an option for patients whose HIV becomes resistant to the older classes of drugs.