Fostemsavir: A Novel Attachment Inhibitor for Patients With Multidrug-Resistant HIV-1 Infection

Ann Pharmacother. 2021 Jun;55(6):792-797. doi: 10.1177/1060028020962424. Epub 2020 Sep 23.

Abstract

Objective: To review the efficacy and safety of fostemsavir (FTR) for the treatment of multidrug-resistant HIV-1 infection in heavily treatment-experienced adults who are failing their current antiretroviral regimen.

Data sources: Clinical trials and review articles were obtained through PubMed (2015 to July 2020) using the search terms fostemsavir, BMS-663068, and GSK3684934.

Study selection and data extraction: All relevant articles, trials, and abstracts in the English language were included.

Data synthesis: FTR demonstrates a novel mechanism of action, preventing virus attachment to the host CD4 receptor. FTR extended-release 600-mg tablets every 12 hours orally has proven beneficial in obtaining viral suppression for heavily treatment-experienced patients with multidrug-resistant infection refractory to other agents, as indicated in phase 3 trials. Treatment courses were evaluated to 96 weeks with significant viral load reductions noted within the first 24 weeks. Adverse events commonly reported include nausea, vomiting, diarrhea, fatigue, and headache. Serious events and fatality were not attributed to FTR and occurred because of advancement of HIV or other acute infection.

Relevance to patient care and clinical practice: FTR presents a new treatment option for patients with multidrug resistance and intolerability to other medications. The favorable adverse effect profile of FTR alongside the limited drug interaction profile makes it a viable option in a salvage regimen.

Conclusions: FTR provides an alternative agent when composing a regimen for patients with multidrug-resistant HIV-1 infection. It is generally well tolerated, with few significant interactions, and neither renal nor hepatic dose adjustments are required.

Keywords: HIV attachment inhibitor; antiretroviral; fostemsavir.

MeSH terms

  • Adult
  • Anti-HIV Agents* / adverse effects
  • HIV Infections* / drug therapy
  • HIV-1*
  • Humans
  • Organophosphates / therapeutic use
  • Piperazines / therapeutic use

Substances

  • Anti-HIV Agents
  • Organophosphates
  • Piperazines
  • fostemsavir