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Latest revision as of 11:30, 7 November 2023 edit undoWikipedialuva (talk | contribs)Autopatrolled, Extended confirmed users, Pending changes reviewers, Rollbackers39,462 editsm →top: clean up, typo(s) fixed: August 27, 2012 → August 27, 2012, (3)Tag: AWB |
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{{Short description|Chemical compound}} |
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{{drugbox |
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{{Infobox drug |
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| Verifiedfields = changed |
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| Verifiedfields = changed |
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| UNII_Ref = {{fdacite|changed|FDA}} |
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| Watchedfields = changed |
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| verifiedrevid = 437144022 |
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| UNII = 4GDQ854U53 |
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| image = Elvitegravir structure.svg |
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| verifiedrevid = 422845789 |
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| image2 = Elvitegravir3D.PNG |
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| IUPAC_name = 6--1--7-methoxy-4-oxoquinoline-3-carboxylic acid |
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| image = Elvitegravir.png |
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<!--Clinical data--> |
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|image2 = Elvitegravir3D.PNG |
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| tradename = Vitekta; ] (fixed-dose combination) |
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| licence_EU = yes |
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| routes_of_administration = ] |
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| ATC_prefix = J05 |
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| ATC_suffix = AJ02 |
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| legal_UK = |
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| legal_US = |
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| legal_status = |
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<!--Pharmacokinetic data--> |
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| bioavailability = |
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| protein_bound = 98% |
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| metabolism = liver, via ] |
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| elimination_half-life = 12.9 (8.7–13.7) hours |
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| excretion = liver 93%, renal 7% |
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<!--Identifiers--> |
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| CAS_number_Ref = {{cascite|correct|??}} |
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| CAS_number = 697761-98-1 |
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| PubChem = 5277135 |
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| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} |
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| ChemSpiderID_Ref = {{chemspidercite|correct|chemspider}} |
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| ChemSpiderID = 4441060 |
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| ChemSpiderID = 4441060 |
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| UNII_Ref = {{fdacite|correct|FDA}} |
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| InChI = 1/C23H23ClFNO5/c1-12(2)19(11-27)26-10-16(23(29)30)22(28)15-8-14(20(31-3)9-18(15)26)7-13-5-4-6-17(24)21(13)25/h4-6,8-10,12,19,27H,7,11H2,1-3H3,(H,29,30)/t19-/m1/s1 |
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| UNII = 4GDQ854U53 |
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| InChIKey = JUZYLCPPVHEVSV-LJQANCHMBZ |
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| ChEBI_Ref = {{ebicite|changed|EBI}} |
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| smiles = Clc1cccc(c1F)Cc3c(OC)cc2c(C(=O)\C(=C/N2(CO)C(C)C)C(=O)O)c3 |
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| ChEBI = 72289 |
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| ChEMBL_Ref = {{ebicite|correct|EBI}} |
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| ChEMBL_Ref = {{ebicite|correct|EBI}} |
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| ChEMBL = 204656 |
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| ChEMBL = 204656 |
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| NIAID_ChemDB = 241767 |
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| KEGG_Ref = {{keggcite|changed|kegg}} |
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| KEGG = D06677 |
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| DrugBank_Ref = {{drugbankcite|changed|drugbank}} |
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| DrugBank = DB09101 |
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| synonyms = GS-9137 |
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<!--Chemical data--> |
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| IUPAC_name = 6--1--7-methoxy-4-oxoquinoline-3-carboxylic acid |
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| C=23 | H=23 | Cl=1 | F=1 | N=1 | O=5 |
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| smiles = Clc1cccc(c1F)Cc3c(OC)cc2c(C(=O)\C(=C/N2(CO)C(C)C)C(=O)O)c3 |
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| StdInChI_Ref = {{stdinchicite|correct|chemspider}} |
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| StdInChI_Ref = {{stdinchicite|correct|chemspider}} |
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| StdInChI = 1S/C23H23ClFNO5/c1-12(2)19(11-27)26-10-16(23(29)30)22(28)15-8-14(20(31-3)9-18(15)26)7-13-5-4-6-17(24)21(13)25/h4-6,8-10,12,19,27H,7,11H2,1-3H3,(H,29,30)/t19-/m1/s1 |
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| StdInChI = 1S/C23H23ClFNO5/c1-12(2)19(11-27)26-10-16(23(29)30)22(28)15-8-14(20(31-3)9-18(15)26)7-13-5-4-6-17(24)21(13)25/h4-6,8-10,12,19,27H,7,11H2,1-3H3,(H,29,30)/t19-/m1/s1 |
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| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} |
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| StdInChIKey_Ref = {{stdinchicite|correct|chemspider}} |
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| StdInChIKey = JUZYLCPPVHEVSV-LJQANCHMSA-N |
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| StdInChIKey = JUZYLCPPVHEVSV-LJQANCHMSA-N |
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| CAS_number = 697761-98-1 |
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| ATC_prefix = none |
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| ATC_suffix = |
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| PubChem = 5277135 |
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| C=23 | H=23 | Cl=1 | F=1 | N=1 | O=5 |
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| molecular_weight = 447.883 g/mol |
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| bioavailability = |
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| protein_bound = |
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| metabolism = |
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| elimination_half-life = |
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| excretion = |
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| pregnancy_US = |
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| legal_UK = |
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| legal_US = |
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| legal_status = |
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| routes_of_administration = |
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}} |
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}} |
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'''Elvitegravir''' (EVG) is an ] for the treatment of ] infection. It acts as an ]. It is undergoing Phase III ]<ref>Gilead Press Release July 22, 2008</ref> conducted by the pharmaceutical company ], which licensed EVG from ] in March 2008.<ref>Gilead Press Release author=Shimura K, Kodama E, Sakagami Y, ''et al.'' |title=Broad Anti-Retroviral Activity and Resistance Profile of a Novel Human Immunodeficiency Virus Integrase Inhibitor, Elvitegravir (JTK-303/GS-9137) |journal=J Virol |volume= 82|issue= 2|pages= 764|year=2007 |pmid=17977962 |doi=10.1128/JVI.01534-07 |url=http://jvi.asm.org/cgi/pmidlookup?view=long&pmid=17977962 |pmc=2224569}}</ref><ref>{{cite journal |author=Stellbrink HJ |title=Antiviral drugs in the treatment of AIDS: what is in the pipeline ? |journal=Eur. J. Med. Res. |volume=12 |issue=9 |pages=483–95 |year=2007 |pmid=17933730 |doi=}}</ref> |
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'''Elvitegravir''' ('''EVG''') is an ] used to treat ] infection. It was developed<ref>{{cite web | work = Gilead Press Release | url = http://www.gilead.com/pr_1177855 | title = Phase III Clinical Trial of Elvitegravir | archive-url = https://web.archive.org/web/20130208062306/http://www.gilead.com/pr_1177855 | archive-date=2013-02-08 | date = 22 July 2008 }}</ref> by the pharmaceutical company ], which licensed EVG from ] in March 2008.<ref>{{cite web | work = Gilead Press Release | url = http://www.gilead.com/pr_687733 | title = Gilead and Japan Tobacco Sign Licensing Agreement for Novel HIV Integrase Inhibitor | archive-url = https://web.archive.org/web/20130208133209/http://www.gilead.com/pr_687733 | archive-date=2013-02-08 | date = March 22, 2008 }}</ref><ref>{{cite journal | vauthors = Shimura K, Kodama E, Sakagami Y, Matsuzaki Y, Watanabe W, Yamataka K, Watanabe Y, Ohata Y, Doi S, Sato M, Kano M, Ikeda S, Matsuoka M | display-authors = 6 | title = Broad antiretroviral activity and resistance profile of the novel human immunodeficiency virus integrase inhibitor elvitegravir (JTK-303/GS-9137) | journal = Journal of Virology | volume = 82 | issue = 2 | pages = 764–774 | date = January 2008 | pmid = 17977962 | pmc = 2224569 | doi = 10.1128/JVI.01534-07 }}</ref><ref>{{cite journal | vauthors = Stellbrink HJ | title = Antiviral drugs in the treatment of AIDS: what is in the pipeline ? | journal = European Journal of Medical Research | volume = 12 | issue = 9 | pages = 483–495 | date = October 2007 | pmid = 17933730 }}</ref> The drug gained approval by the U.S. ] on August 27, 2012, for use in adult patients starting HIV treatment for the first time as part of the ] known as ].<ref>{{cite journal | vauthors = Sax PE, DeJesus E, Mills A, Zolopa A, Cohen C, Wohl D, Gallant JE, Liu HC, Zhong L, Yale K, White K, Kearney BP, Szwarcberg J, Quirk E, Cheng AK | display-authors = 6 | title = Co-formulated elvitegravir, cobicistat, emtricitabine, and tenofovir versus co-formulated efavirenz, emtricitabine, and tenofovir for initial treatment of HIV-1 infection: a randomised, double-blind, phase 3 trial, analysis of results after 48 weeks | journal = Lancet | volume = 379 | issue = 9835 | pages = 2439–2448 | date = June 2012 | pmid = 22748591 | doi = 10.1016/S0140-6736(12)60917-9 | s2cid = 24183976 }}</ref> On September 24, 2014, the FDA approved Elvitegravir as a single pill formulation under the trade name '''Vitekta'''.<ref>{{cite web | url = http://content.govdelivery.com/accounts/USFDA/bulletins/d162bb | title = FDA Approval Bulletin | archive-url = https://web.archive.org/web/20141103062906/http://content.govdelivery.com/accounts/USFDA/bulletins/d162bb | archive-date=2014-11-03 }}</ref> On November 5, 2015, the FDA approved the drug for use in patients affected with HIV-1 as a part of a second fixed dose combination pill known as ].<ref>{{Cite web|title = Press Announcements - FDA approves new treatment for HIV|url = https://www.fda.gov/NewsEvents/Newsroom/PressAnnouncements/ucm471300.htm|website = www.fda.gov|access-date = 2016-01-10|language = en}}</ref> |
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According to the results of the phase II clinical trial, patients taking once-daily elvitegravir boosted by ] had greater reductions in ] after 24 weeks compared to individuals randomized to receive a ritonavir-boosted ].<ref>Thaczuk, Derek and Carter, Micheal. Aidsmap.com. 19 Sept. 2007.</ref> |
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According to the results of the phase II clinical trial, patients taking once-daily elvitegravir boosted by ] had greater reductions in ] after 24 weeks compared to individuals ] to receive a ritonavir-boosted ].<ref>{{cite web | vauthors = Thaczuk D, Carter M | url = https://www.aidsmap.com/news/sep-2007/icaac-best-response-elvitegravir-seen-when-used-t-20-and-other-active-agents | title = ICAAC: Best response to elvitegravir seen when used with T-20 and other active agents | archive-url = https://web.archive.org/web/20100102230214/http://aidsmap.com/en/news/69FAE9A0-307D-430B-8023-DA133AD0CEDB.asp | archive-date=2010-01-02 | work = Aidsmap.com | date = 19 September 2007 }}</ref> |
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==References== |
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==Medical uses== |
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In the United States, elvitegravir can be obtained either as part of the combination pills ] or ], or as the single pill formulation Vitekta.<ref>{{cite web | url = http://www.accessdata.fda.gov/scripts/cder/drugsatfda/index.cfm | title = FDA Approved Drug Listing | access-date = March 3, 2017 }}</ref> |
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Vitekta is ] approved to be used for the treatment of HIV-1 infection in adults who have previous treatment experience with ]. It must be used in combination with a protease inhibitor that is coadministered with ] as well as additional antiretroviral drug(s).<ref name = "PI">{{cite web | url = http://dailymed.nlm.nih.gov/dailymed/drugInfo.cfm?setid=be87c3bc-97bb-49cb-8053-9b0c756a1965#section-1 | title = Vitekta Package Insert | location = Foster City, CA | publisher = Gilead Sciences, Inc. | date = 2014 | access-date = November 1, 2014 | via = U.S. Food and Drug Administration }}</ref> |
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==Adverse effects== |
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The most common side effects of taking elvitegravir are ] (in 7% of patients) and ] (4%). Other side effects that occurred in more than 1% of people are ], ], ], and ].<ref name = "PI" /><ref name="AC">{{cite book|title=Austria-Codex| veditors = Haberfeld H|publisher=Österreichischer Apothekerverlag|location=Vienna|year=2015|language=de}}</ref> |
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==Interactions and contraindications== |
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Elvitegravir is metabolised via the liver enzyme ]. Substances that induce this enzyme can reduce elvitegravir concentrations in the body, potentially triggering the development of ] virus strains. Consequently, co-administration of strong CYP3A inducers is contraindicated; examples are ], the anticonvulsants ], ] and ], as well as ].<ref name="AC" /> |
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] of elvitegravir is facilitated by the enzymes ] and ], resulting in increased blood plasma levels when taken together with strong UGT1A inhibitors such as ] and other ]s.<ref name="AC" /><ref>{{cite journal | vauthors = Zhang D, Chando TJ, Everett DW, Patten CJ, Dehal SS, Humphreys WG | title = In vitro inhibition of UDP glucuronosyltransferases by atazanavir and other HIV protease inhibitors and the relationship of this property to in vivo bilirubin glucuronidation | journal = Drug Metabolism and Disposition | volume = 33 | issue = 11 | pages = 1729–1739 | date = November 2005 | pmid = 16118329 | doi = 10.1124/dmd.105.005447 | s2cid = 1964934 }}</ref> (But ritonavir also increases elvitegravir levels by inhibiting CYP3A.) |
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Furthermore, elvitegravir is a weak to medium inducer of ], ], ], CYP3A, and a number of ]s; the clinical relevance of these findings is however unclear.<ref name="AC" /> |
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==Pharmacology== |
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===Mechanism of action=== |
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Elvitegravir inhibits the enzyme ] of ], and of HIV-2 to a lesser extent. The virus needs this enzyme to integrate its genetic code into the host's ].<ref name="AC" /> |
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===Pharmacokinetics=== |
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The drug is taken by mouth. When taken together with ritonavir and a meal, it reaches highest blood plasma concentrations after four hours. ] is better with fatty meals. In the bloodstream, 98–99% of the substance are bound to ]s. It is metabolized mainly by CYP3A oxidation, and secondly by UGT1A1 and 3 glucuronidation. Nearly 95% are excreted via the feces, and the rest via urine. ] when combined with ritonavir is 8.7 to 13.7 hours.<ref name="AC" /> |
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== References == |
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{{reflist}} |
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{{reflist}} |
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== External links == |
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{{HIVpharm}} |
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* {{cite web | url = https://druginfo.nlm.nih.gov/drugportal/name/elvitegravir | publisher = U.S. National Library of Medicine | work = Drug Information Portal | title = Elvitegravir }} |
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{{Antiretroviral drug}} |
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