GRACE—The largest clinical trial in North America of
treatment-experienced (TE) women with HIV/AIDS

Provided gender-specific data on the efficacy and safety of
PREZISTA/r + optimized background regimen (OBR)

GRACE Trial design5

  • A prospective, multicenter, open-label, 48-week, Phase 3b study designed to assess gender-based differences in the efficacy and safety of PREZISTA/r-based therapy among TE adults
  • All patients received PREZISTA/r 600/100 mg twice daily plus investigator-selected OBR
    • Zidovudine, emtricitabine, tenofovir, tenofovir/emtricitabine and etravirine (ETR) were provided in the study, but not mandated for use
    • Enfuvirtide (ENF), tipranavir (TPV), integrase inhibitors and CCR5 antagonists were not allowed as part of the OBR

Primary objective5

  • To evaluate gender-based differences in virologic response
    (HIV-1 RNA <50 copies/mL) at Week 48

Secondary objectives5

  • To evaluate change in CD4+ count from baseline to Week 48
  • To evaluate safety and tolerability of PREZISTA/r over 48 weeks

Baseline characteristics5

Of the 429 patients enrolled in GRACE, 67% were women and 33% were men5
  • In GRACE, the proportion of women who were Black (67%) and/or Hispanic (21%) reflects national HIV demographics3,5

*Based on the IAS-USA list of mutations 2008. Primary PI mutations: D30N,V32I, L33F, M46I/L,   I47A/V, G48V, I50L/V, I54L/M, Q58E, T74P, L76V,V82A/F/L/S/T, I84V, N88S, and L90M.

INDICATION: ADULTS

PREZISTA® (darunavir) tablets, co-administered with ritonavir (PREZISTA/r), and with other antiretroviral agents (ARVs), is indicated for the treatment of human immunodeficiency virus (HIV-1) infection.

This indication is based on analyses of plasma HIV RNA levels and CD4+ cell counts from 2 controlled Phase 3 trials of 48 weeks' duration in ARV treatment-naïve and treatment-experienced patients and 2 controlled Phase 2 trials of 96 weeks' duration in clinically advanced, treatment-experienced adult patients.

In treatment-experienced adult patients, the following points should be considered when initiating therapy with PREZISTA/r:

  • Treatment history and, when available, genotypic or phenotypic testing, should guide the use of PREZISTA/r
  • The use of other active agents with PREZISTA/r is associated with a greater likelihood of treatment response

IMPORTANT SAFETY INFORMATION

Drug Interactions

  • Coadministration of PREZISTA/r is contraindicated with drugs that are highly dependent on CYP3A for clearance and for which elevated plasma concentrations are associated with serious and/or life-threatening events (eg, alfuzosin, dihydroergotamine, ergonovine, ergotamine, methylergonovine, cisapride, pimozide, oral midazolam, triazolam, lovastatin, simvastatin, or sildenafil for the treatment of pulmonary arterial hypertension)
  • Coadministration of PREZISTA/r is also contraindicated with rifampin and products containing St. John's wort (Hypericum perforatum) because this may cause significant decrease in plasma concentration of darunavir, resulting in loss of therapeutic effect and development of resistance
  • Coadministration is not recommended with indinavir, lopinavir/ritonavir, saquinavir, pravastatin, salmeterol, and colchicine in patients with hepatic or renal impairment
  • Caution should be used when prescribing agents such as sildenafil, vardenafil, tadalafil, or other substrates, inhibitors, or inducers of CYP3A in patients receiving PREZISTA/r. This list of potential drug interactions is not complete

Warnings & Precautions

  • PREZISTA must be coadministered with ritonavir and food to achieve the desired antiviral effect. Failure to administer PREZISTA with ritonavir and food may result in a loss of efficacy of darunavir. Please refer to ritonavir prescribing information for additional information on precautionary measures
  • Drug-induced hepatitis (eg, acute hepatitis, cytolytic hepatitis) has been reported with PREZISTA/r. During the clinical development program (N=3063), hepatitis has been reported in 0.5% of patients receiving combination therapy with PREZISTA/r. Patients with preexisting liver dysfunction, including chronic active hepatitis B or C, have an increased risk for liver function abnormalities, including severe hepatic adverse events

    Postmarketing cases of liver injury, including some fatalities, have been reported. A causal relationship with PREZISTA/r therapy has not been established

    Appropriate laboratory testing should be conducted prior to initiating therapy with PREZISTA/r and patients should be monitored during treatment. Increased AST/ALT monitoring should be considered in patients with underlying chronic hepatitis, cirrhosis, or in patients who have pretreatment elevations of transaminases, especially during the first several months of PREZISTA/r treatment. Evidence of new or worsening liver dysfunction (including clinically significant elevation of liver enzymes and/or symptoms such as fatigue, anorexia, nausea, jaundice, dark urine, liver tenderness, hepatomegaly) in patients on PREZISTA/r should prompt consideration of interruption or discontinuation of treatment
  • Severe Skin Reactions: Severe skin reactions (0.4%), accompanied by fever and/or elevations of transaminases in some cases, Stevens-Johnson syndrome (<0.1%), and toxic epidermal necrolysis (postmarketing experience) have been reported in patients receiving PREZISTA/r. Discontinue PREZISTA/r immediately if signs or symptoms of severe skin reactions develop (including, but not limited to, severe rash or rash accompanied with fever, general malaise, fatigue, muscle or joint aches, blisters, oral lesions, conjunctivitis, hepatitis, and/or eosinophilia)

    In clinical trials (N=3063), rash (all grades, generally mild to moderate, regardless of causality) occurred in 10.3% of patients receiving PREZISTA/r. Discontinuation due to rash was 0.5%
  • Sulfa Allergy: PREZISTA should be used with caution in patients with known sulfonamide allergy
  • Diabetes Mellitus/Hyperglycemia and Hemophilia: New-onset or exacerbations of preexisting diabetes mellitus, hyperglycemia, and increased bleeding in hemophiliacs have been reported in patients receiving protease inhibitors. Initiation or dose adjustments of insulin or oral hypoglycemic agents may be required. A causal relationship between protease inhibitors and these events has not been established
  • Fat Redistribution: Redistribution and/or accumulation of body fat have been observed in patients receiving ARV therapy. The causal relationship, mechanism, and long-term consequences of these events have not been established
  • Immune reconstitution syndrome has been reported in patients treated with ARV therapy
  • Resistance/Cross-Resistance: The potential for HIV cross-resistance among protease inhibitors has not been fully explored in PREZISTA/r-treated patients

Use in Specific Populations

  • Hepatic impairment: PREZISTA/r is not recommended for use in patients with severe hepatic impairment. There are no pharmacokinetic or safety data available in patients with severe hepatic impairment
  • Pregnancy: PREZISTA should be used during pregnancy only if the potential benefit justifies the potential risk. No adequate and well-controlled studies have been conducted in pregnant women

Adverse Reactions

  • In treatment-naïve adult patients, the most common adverse drug reactions (≥5%) reported of at least moderate intensity (≥Grade 2) in the PREZISTA/r arm through 96 weeks were diarrhea (8%), headache (6%), abdominal pain (5%), and
    rash (5%)
  • In treatment-experienced adult patients, the most common adverse drug reactions (≥5%) reported of at least moderate intensity (≥Grade 2) in the PREZISTA/r arm through 96 weeks were diarrhea (14%), nausea (7%), rash (7%), abdominal pain (6%), and vomiting (5%)

This is not a complete list of all adverse drug reactions reported with the use of PREZISTA/r.

Please see the full Prescribing Information in PDF format for more details.