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3yr
New option for treating multidrug-resistant HIV

The introduction of triple-drug therapies brought hopes that drug resistance in HIV would be vanquished. It was hypothesized that because each of these 3 drugs individually decreased the R0 (i.e., basic reproductive number) below one, any HIV mutations conferring resistance against one class of HIV agent could be offset by the other two classes of drugs. Nevertheless, HIV defied expectations and evolved to develop resistance against triple therapy for unknown reasons.

In July 2020, the FDA approved fostemsavir (Rukobia) for the treatment of heavily-treatment-experienced patients with multidrug resistance who cannot be treated with other agents due to resistance, safety concerns, contraindications, or intolerability. In this select patient population, fostemsavir can be integrated into treatment plans as an effective core component.

Fostemsavir belongs to a novel class of antiretroviral drugs and exhibits no observed cross-resistance. The active moiety temsavir attaches to the viral envelope protein gp120 located on the surface of HIV-1 virions; this prevents viral entry and leaves CD4+ T-cells undisturbed. In a phase 3 trial, patients who were experiencing treatment failure with viral loads ≥400 copies/mL or had 2 or fewer antiretroviral classes remaining at baseline were studied. By week 96, 60% of 272 randomized patients receiving fostemsavir plus optimized background therapy (OBT) attained virologic suppression. Moreover, all patients—even those who were most severely immunocompromised at baseline—experienced robust CD4+ T-cell recovery.

 What has your experience been with fostemsavir in heavily-treatment-experienced patients with multidrug resistance? How should this therapy fit into current treatment plans?

  • 3yr
    Fostemsavir belongs to a novel class of antiretroviral drugs and exhibits no observed cross-resistance.
  • 3yr
    I reserve this drug as a salvage therapy. With little side effects it might be used more commonly but the limiting factors remain lack of experience and scarcity in clinical data
  • 3yr
    Seems promising esp. for HIV patients who developed resistance to their current Rx
  • 3yr
    No experience with this medication. Treatment usually handled by specialists
  • 3yr
    I personally don't have any experience with this drug but based on the Phase 3 trial, this drug showed very bright future Rx for patients who have experience multidrug resistance
  • 3yr
    Comanage lot of HIV patients with ID colleagues and Rubokia has been a block buster drug for the multidrug resistance and seems to be well tolerated defintely a major breakthrough in managing complicated HIV patients
  • 3yr
    I have not had the need to prescribe this. It has a major role in multi-drug resistant HIV. I think the bid dosing will be an issue for non-compliant patients. Very interesting mechanism of action.
  • 3yr
    Good efficacy, excellent safety. Have not seen or heard of resistance with this gp 120 entry inhibitor.
  • 3yr
    Have few patients on this drug and it has worked well with no major side effects.
    Great new addition to anti HIV drugs
  • 3yr
    It has worked well with minimal tolerability issue and side effect. It is a great add on or adjunctive therapy with other agents.
  • 3yr
    I co-manage my HIV patients with ID. I defer to their choice of antiviral therapy. That stated, new treatments are essential to overcome resistance as vaccine development had not been promising.
  • 3yr
    It has been working well…effective with minimal side effects
  • 3yr
    Fortunately, I have not seen much resistance in my practice. It is good to know that Rukobia is available. Formulary status may be a limiting factor, however.
  • 3yr
    It is always beneficial to have options to treat HIV with multi drug resistance along with
    2 other active HIV meds and i have used Rukobia effectively
    Follow up and lab monitoring are imperative when using any new agent for HIV
    It is important to impress on the HIV patient the need for close follow up
  • 3yr
    I have not changed any patients plan yet. Insurance/formulary restrictions will limit prescribing , I am confident in time these restrictions will change
  • 3yr
    I have not used yet because my patients does not have resistance virus. All of them are on once a day regimen but Rukobia is in my mind to use when I need it
  • 3yr
    I have very few pts who need this. Most do fine on a once daily regimen. But it does have its role in those who have limited options
  • 3yr
    Also didn't have opportunity to see clients on this therapy but excited to learn more about it
  • 3yr
    I have been treating HIV since single drug therapy(in the old days), and then when 3 drug therapy began, i treated all patients that way. Well resistance was new then, and once finally understood, adjusting treatments became the norm. As simpler once daily treatments began, resistance still occurred due to noncompliance. So with Rukobia, which i have used in some of those patients, allows the patient to still have options to keep HIV suppressed. Along with 2 other active HIV meds. Authorization is always a issue and we persevere and get the med covered.
  • 3yr
    I have not had the opportunity to prescribe this med. Most of my patients are on the traditional meds and are doing fine. When the time comes, I'll be sure to keep fostersavir in mind.
  • 3yr
    Not had much of an opportunity to use due to formulary restrictions, but those few that take it have tolerated it well. I see it's use increasing in the future and resistance continues to be an issue
  • 3yr
    With very narrow treatment options, Rukobia usage has been increasing. I have not had patients require discontinuation due to side effects. HIV patients that are hospitalized often cannot continue Rokubia due to it commonly being not included on formulary. With good sustained virologic response rates, low incidence of adverse effects, and patient tolerability, I can see this drug fitting into more treatment plans in the future.

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