EMTRIVA SIDE EFFECTS
- Generic Name: emtricitabine
- Brand Name: Emtriva
- Drug Class: HIV, NNRTIs
SIDE EFFECTS
The following adverse reactions are discussed in other sections of the labeling:
- Severe Acute Exacerbation of Hepatitis B in Patients Coinfected with HIV-1 and HBV.
- Immune Reconstitution Syndrome.
- Lactic Acidosis/Severe Hepatomegaly with Steatosis.
Clinical Trials Experience
Because clinical trials are conducted under widely varying conditions, adverse reaction rates observed in the clinical trials of a drug cannot be directly compared to rates in the clinical trials of another drug and may not reflect the rates observed in practice.
Adverse Reactions From Clinical Trials Experience In Adults
More than 2,000 adult subjects with HIV-1 infection have been treated with EMTRIVA alone or in combination with other antiretroviral agents for periods of 10 days to 200 weeks in clinical trials. The most common adverse reactions (incidence greater than or equal to 10%, any severity) identified from any of the three large, controlled clinical trials include headache, diarrhea, nausea, fatigue, dizziness, depression, insomnia, abnormal dreams, rash, abdominal pain, asthenia, increased cough, and rhinitis.
In Trials 301A and 303, the most common adverse reactions that occurred in subjects receiving EMTRIVA with other antiretroviral agents were headache, diarrhea, nausea, and rash, which were generally mild to moderate. Approximately 1% of subjects discontinued participation in the clinical trials due to these events. All adverse reactions were reported with similar frequency in EMTRIVA and control treatment groups except for skin discoloration, which was reported with higher frequency in the EMTRIVA-treated group.
Skin discoloration, manifested by hyperpigmentation on the palms or soles, was generally mild and asymptomatic. The mechanism and clinical significance are unknown.
A summary of EMTRIVA treatment-emergent clinical adverse reactions in Trials 301A and 303 is provided in Table 2.
Table 1 : Selected Treatment-Emergent Adverse Reactions (All Grades, Regardless of Causality) Reported in ≥3% of EMTRIVA-Treated Subjects in Either Trial 301A or 303 (0-48 Weeks)
| 303 | 301A | |||
| EMTRIVA + AZT/d4T + NNRTI/PI (N=294) |
3TC + AZT/d4T + NNRTI/PI (N=146) |
EMTRIVA + didanosine + EFV (N=286) |
d4T + didanosine + EFV (N=285) |
|
| Body as a Whole | ||||
| Asthenia | 16% | 10% | 12% | 17% |
| Headache | 13% | 6% | 22% | 25% |
| Abdominal pain | 8% | 11% | 14% | 17% |
| Digestive System | ||||
| Diarrhea | 23% | 18% | 23% | 32% |
| Nausea | 18% | 12% | 13% | 23% |
| Vomiting | 9% | 7% | 9% | 12% |
| Dyspepsia | 4% | 5% | 8% | 12% |
| Musculoskeletal | ||||
| Myalgia | 4% | 4% | 6% | 3% |
| Arthralgia | 3% | 4% | 5% | 6% |
| Nervous System | ||||
| Insomnia | 7% | 3% | 16% | 21% |
| Depressive disorders | 6% | 10% | 9% | 13% |
| Paresthesia | 5% | 7% | 6% | 12% |
| Dizziness | 4% | 5% | 25% | 26% |
| Neuropathy/peripheral neuritis | 4% | 3% | 4% | 13% |
| Abnormal dreams | 2% | <1% | 11% | 19% |
| Respiratory | ||||
| Rhinitis | 18% | 12% | 12% | 10% |
| Increased cough | 14% | 11% | 14% | 8% |
| Skin | ||||
| Rash eventa | 17% | 14% | 30% | 33% |
| AZT=zidovudine; d4T=stavudine; NNRTI/PI=non-nucleoside reverse transcriptase inhibitor/protease inhibitor; 3TC=lamivudine; EFV=efavirenz. a Rash event includes rash, pruritus, maculopapular rash, urticaria, vesiculobullous rash, pustular rash, and allergic reaction. |
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Laboratory Abnormalities
Laboratory abnormalities in these trials occurred with similar frequency in the EMTRIVA and comparator groups. A summary of Grades 3-4 laboratory abnormalities is provided in Table 3.
Table 2 : Treatment-Emergent Grades 3-4 Laboratory Abnormalities Reported in ≥1% of EMTRIVA-Treated Subjects in Either Trial 301A or 303
| 303 | 301A | |||
| EMTRIVA + AZT/d4T + NNRTI/PI (N=294) |
3TC + AZT/d4T + NNRTI/PI (N=146) |
EMTRIVA + Didanosine + EFV (N=286) |
d4T + Didanosine + EFV (N=285) |
|
| Any ≥ Grade 3 Laboratory Abnormality | 31% | 28% | 34% | 38% |
| ALT (>5.0 x ULNa) | 2% | 1% | 5% | 6% |
| AST (>5.0 x ULN) | 3% | <1% | 6% | 9% |
| Bilirubin (>2.5 x ULN) | 1% | 2% | <1% | <1% |
| Creatine kinase (>4.0 x ULN) | 11% | 14% | 12% | 11% |
| Neutrophils (<750 mm3) | 5% | 3% | 5% | 7% |
| Pancreatic amylase (>2.0 x ULN) | 2% | 2% | <1% | 1% |
| Serum amylase (>2.0 x ULN) | 2% | 2% | 5% | 10% |
| Serum glucose <40 or >250 mg/dL) | 3% | 3% | 2% | 3% |
| Serum lipase (>2.0 x ULN) | <1% | <1% | 1% | 2% |
| Triglycerides (>750 mg/dL) | 10% | 8% | 9% | 6% |
| a ULN = Upper limit of normal | ||||
In Trial 934, 511 antiretroviral-naive subjects received efavirenz (EFV) administered in combination with either EMTRIVA + tenofovir disoproxil fumarate (TDF) (N=257) or AZT/3TC (N=254) for 144 weeks. The most common adverse reactions (incidence greater than or equal to 10%, all grades) included diarrhea, nausea, fatigue, headache, dizziness, depression, insomnia, abnormal dreams, and rash. Table 4 provides the treatment-emergent adverse reactions (Grades 2-4) occurring in greater than or equal to 5% of subjects treated in any treatment group.
Table 3 : Selected Adverse Reactionsa (Grades 2-4) Reported in ≥5% in Any Treatment Group in Trial 934 (0-144 Weeks)
| EMTRIVA + TDF + EFVb N=257 |
AZT/3TC + EFV N=254 |
|
| Fatigue | 9% | 8% |
| Depression | 9% | 7% |
| Nausea | 9% | 7% |
| Diarrhea | 9% | 5% |
| Dizziness | 8% | 7% |
| Upper respiratory tract infections | 8% | 5% |
| Sinusitis | 8% | 4% |
| Rash eventc | 7% | 9% |
| Headache | 6% | 5% |
| Insomnia | 5% | 7% |
| Nasopharyngitis | 5% | 3% |
| Vomiting | 2% | 5% |
| a Frequencies of adverse reactions are based on all treatment-emergent adverse events, regardless of relationship to study drug. b From Weeks 96 to 144 of the trial, subjects received TRUVADA® with EFV in place of EMTRIVA + TDF with EFV. c Rash event includes rash, exfoliative rash, rash generalized, rash macular, rash maculo-papular, rash pruritic, and rash vesicular. |
||
Laboratory Abnormalities
Laboratory abnormalities observed in Trial 934 were generally consistent with those seen in previous trials (Table 5).
Table 4 : Significant Laboratory Abnormalities Reported in ≥1% of Subjects in Any Treatment Group in Trial 934 (0-144 Weeks)
| EMTRIVA + TDF + EFVa N=257 |
AZT/3TC + EFV N=254 |
|
| Any ≥ Grade 3 Laboratory Abnormality | 30% | 26% |
| Fasting Cholesterol (>240 mg/dL) | 22% | 24% |
| Creatine Kinase (M: >990 U/L) (F: >845 U/L) | 9% | 7% |
| Serum Amylase (>175 U/L) | 8% | 4% |
| Alkaline Phosphatase (>550 U/L) | 1% | 0% |
| AST (M: >180 U/L) (F: >170 U/L) | 3% | 3% |
| ALT (M: >215 U/L) (F: >170 U/L) | 2% | 3% |
| Hemoglobin (<8.0 mg/dL) | 0% | 4% |
| Hyperglycemia (>250 mg/dL) | 2% | 1% |
| Hematuria (>75 RBC/HPF) | 3% | 2% |
| Glycosuria (3+) | <1% | 1% |
| Neutrophils (<750/mm³) | 3% | 5% |
| Fasting Triglycerides (>750 mg/dL) | 4% | 2% |
| a From Weeks 96 to 144 of the trial, subjects received TRUVADA with EFV in place of EMTRIVA + TDF with EFV. | ||
Adverse Reactions From Clinical Trials Experience In Pediatric Subjects
Assessment of adverse reactions in pediatric subjects is based on data from Trial 203, an open label, uncontrolled trial of 116 HIV-1 infected subjects who received FTC through 48 weeks. The adverse reaction profile in pediatric subjects was generally comparable to that observed in clinical trials of EMTRIVA in adult subjects. Hyperpigmentation was more frequent in children. Additional adverse reactions identified from this trial include anemia.
Selected treatment-emergent adverse events, regardless of causality, reported in subjects during 48 weeks of treatment were the following: infection (44%), hyperpigmentation (32%), increased cough (28%), vomiting (23%), otitis media (23%), rash (21%), rhinitis (20%), diarrhea (20%), fever (18%), pneumonia (15%), gastroenteritis (11%), abdominal pain (10%), and anemia (7%). Treatment-emergent Grades 3-4 laboratory abnormalities were experienced by 9% of pediatric subjects, including elevated amylase (>2.0 > ULN) (n=4), decreased neutrophils (<750/mm³) (n=3), elevated ALT (>5 > ULN) (n=2), elevated CPK (>4 > ULN) (n=2) and one subject each with elevated bilirubin (>3.0 > ULN), elevated GGT (>10 > ULN), elevated lipase (>2.5 > ULN), decreased hemoglobin (<7 g/dL), and decreased glucose (<40 mg/dL).
SRC: NLM .