Clinical Pharmacokinetics and Pharmacodynamics of Etravirine: An Updated Review

Clin Pharmacokinet. 2020 Feb;59(2):137-154. doi: 10.1007/s40262-019-00830-9.

Abstract

Etravirine is a second-generation non-nucleoside reverse transcriptase inhibitor (NNRTI) for the treatment of human immunodeficiency virus type 1 infection. It is a potent inhibitor of HIV reverse transcriptase and retains activity against wild-type and most NNRTI-resistant HIV. The pharmacokinetic profile of etravirine and clinical data support twice-daily dosing, although once-daily dosing has been investigated in treatment-naïve and treatment-experienced persons. Despite similar pharmacokinetic and pharmacodynamic results compared with twice-daily dosing, larger studies are needed to fully support once-daily etravirine dosing in treatment-naïve individuals. Etravirine is reserved for use in third- or fourth-line antiretroviral treatment regimens, as recommended, for example, in treatment guidelines by the US Department of Health and Human Services-Guidelines for the Use of Antiretroviral Agents in Adults and Adolescents Living with HIV. Etravirine exhibits the potential for bi-directional drug-drug interactions with other antiretrovirals and concomitant medications through its interactions with cytochrome P450 (CYP) isozymes: CYP3A4, CYP2C9, and CYP2C19. This review summarizes the pharmacokinetic and pharmacodynamic parameters of etravirine, with particular attention to information on drug-drug interactions and use in special patient populations, including children/adolescents, women, persons with organ dysfunction, and during pregnancy.

Publication types

  • Comparative Study
  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Adolescent
  • Adult
  • Anti-Retroviral Agents / therapeutic use
  • Biological Availability
  • Cytochrome P-450 CYP2C19 / drug effects
  • Cytochrome P-450 CYP2C19 / metabolism
  • Cytochrome P-450 CYP2C9 / drug effects
  • Cytochrome P-450 CYP2C9 / metabolism
  • Cytochrome P-450 CYP3A / drug effects
  • Cytochrome P-450 CYP3A / metabolism
  • Cytochrome P-450 Enzyme System / drug effects
  • Cytochrome P-450 Enzyme System / metabolism
  • Drug Interactions
  • Female
  • HIV Infections / drug therapy*
  • HIV Infections / virology
  • HIV-1 / drug effects*
  • HIV-1 / isolation & purification
  • Humans
  • Male
  • Multiple Organ Failure / drug therapy*
  • Nitriles / administration & dosage
  • Nitriles / pharmacokinetics*
  • Nitriles / therapeutic use
  • Pharmacogenetics
  • Pregnancy
  • Pyrimidines / administration & dosage
  • Pyrimidines / pharmacokinetics*
  • Pyrimidines / therapeutic use
  • Reverse Transcriptase Inhibitors / administration & dosage
  • Reverse Transcriptase Inhibitors / pharmacokinetics*
  • Reverse Transcriptase Inhibitors / therapeutic use

Substances

  • Anti-Retroviral Agents
  • Nitriles
  • Pyrimidines
  • Reverse Transcriptase Inhibitors
  • etravirine
  • Cytochrome P-450 Enzyme System
  • Cytochrome P-450 CYP2C9
  • Cytochrome P-450 CYP2C19
  • Cytochrome P-450 CYP3A