Descovy vs truvada for prep

[Mikegaite]

I was under the impression that descovy was going to be approved pretty soon for prep for cisgender men. I thought data implied that it was superior to truvada for prep, with equal efficacy but fewer side effects. Am not so sure after reading this. Thoughts?

 

https://www.medscape.com/viewarticle/916635

[+ honcho]

I was under the impression that descovy was going to be approved pretty soon for prep for cisgender men. I thought data implied that it was superior to truvada for prep, with equal efficacy but fewer side effects. Am not so sure after reading this. Thoughts?

 

https://www.medscape.com/viewarticle/916635

 

My partner is HIV+ and his primary care doctor changed his prescription from Truvada to Descovy, and he was told that it was as effective in *controlling* HIV as truvada with fewer side effects. [standard HIV treatment requires a third anti-retroviral]. His switch was done about 6 months ago, and his HIV load is still undetectable.

 

I read the medscape article as saying there hasn't been enough clinical trials to prove the effectiveness in *prevention* and lack of side effects in all classes of patients (particularly women and some people of color). [update: I read only the first of 3 pages initially. Subsequently, one of the concerns stated was whether Descovy would be as effective as Truvade at stopping vaginal infection, and the concern was that this was completely ignored in the trials].

 

It would seem to me highly likely that if a medicine is good at stopping replication when a person is infected, it would be good at preventing infection, so that if it were offered to me as part of a clinical trial, I wouldn't hesistate at all. (And the diminishment of side effects in the population of those already infected has been established as well). But then, some things in nature defy logic.

Edited August 9, 2019 by honcho

[+ nycman]

I was under the impression that descovy was going to be approved pretty soon for prep for cisgender men. I thought data implied that it was superior to truvada for prep, with equal efficacy but fewer side effects. Am not so sure after reading this. Thoughts?

 

https://www.medscape.com/viewarticle/916635

If you’re not a cis-gendered female, I don’t see why that article

would color your decision to use Descovy or not. It’s all about the

FDA getting pissed that they didn’t include cis-gendered females in

their study.

 

Fair enough, but it doesn’t invalidate their findings. It just limits the

generalizations you can make to the population as a whole. There

is little reason to believe it won’t protect cis-gendered females, but

the drug company choose to punt on the topic. Unfortunately, it

looks like the FDA panel is trying to punish them for this, and thus

potentially keeping the drug out of the hands of patients that it

HAS been proven to protect.

 

It’s gender politics....masquerading as science.

[rvwnsd]

It appears that Descovy is being recommended for approval for use as PrEP in cisgender men, but not in cisgender women, given the lack of data around its safety and efficacy in cisgender women. That makes perfect sense to me and I am not a woman (cisgender or otherwise). I wouldn't want a drug to be approved for use in cisgender men and women when it was not studied and successfully tested in cisgender men.

Edited August 9, 2019 by rvwnsd

[+ BenjaminNicholas]

An article a little more down the middle...

 

https://www.nbcnews.com/feature/nbc-out/fda-backs-gilead-s-hiv-prevention-drug-descovy-use-prep-n1040416

[+ quoththeraven]

If you’re not a cis-gendered female, I don’t see why that article

would color your decision to use Descovy or not. It’s all about the

FDA getting pissed that they didn’t include cis-gendered females in

their study.

 

Fair enough, but it doesn’t invalidate their findings. It just limits the

generalizations you can make to the population as a whole. There

is little reason to believe it won’t protect cis-gendered females, but

the drug company choose to punt on the topic. Unfortunately, it

looks like the FDA panel is trying to punish them for this, and thus

potentially keeping the drug out of the hands of patients that it

HAS been proven to protect.

 

It’s gender politics....masquerading as science.

Considering that for years research has ignored women and thus not noticed differences in presentation of symptoms or the efficacy and safety of drugs, calling this "gender politics...masquerading as science" is insulting. The people who have died, suffered and been misdiagnosed because women aren't included in studies would disagree with you.

[+ keroscenefire]

I would say as long as you are not having any major side effects and you're not seeing any liver or kidney damage, stick with Truvada. For one, Gilead is a kind of terrible company, charging insane amounts for a drug use that they did not develop. Their whole thing with Descovy is to keep the gigantic PReP profits once Truvada goes generic by getting everyone to use the "safer" drug.

 

The one meta-study I found about Tenofovir (the component of Truvada that may damage the liver) showed a significant but very small percentage (less than 1 percent) of those taking the medicine got liver damage with the vast majority of them being coinfected with hepatitis. See: https://www.catie.ca/en/catienews/2016-02-10/does-tenofovir-cause-liver-injury/ Slight kidney impairment may also occur but was also very moderate and mostly effected those who already had kidney impairment of some kind (see: https://www.sfaf.org/collections/beta/new-research-at-croi-2016-how-prep-changes-kidney-function/)

 

This is why those of us taking Truvada are monitored for kidney and liver function. If there are any issues, then yeah, Discovey may be better. But if not, just keep taking Truvada and start using the much cheaper generic version as soon as possible so we can stop giving too much of our money to Gilead's shareholders.

[+ robear]

For those covered by commercial (employer paid) insurance and prescription management, it's likely that current coverage of Truvada will require a move to the generic when available. Brand-name Descovy might then be very expensive to the patient when there is a generic alternative. I pay nothing OOP for generics, but a substantial % of the retail for a brand name when a generic "equivalent" is available.

[Rudynate]

Generic Truvada = Tenvir EM. $55.00 monthly from India.

[+ oldNbusted]

FDA OKs Descovy, Second Drug for HIV PrEP

 

I hope further testing gets it approved for women.

[sincitymix]

Generic Truvada = Tenvir EM. $55.00 monthly from India.

 

and in the united states it'll probably be 500 a month.

[+ robear]

It looks like Gilead is including Descovy in its copay coverage program for patients with commercial insurance. As with Truvada, you register with Gilead and they send a card that you present to a retail (NOT mail order) pharmacy to have your copay waived, hence $0 out of pocket.