Question
What is the difference between Delstrigo and Symtuza?
7 March 2022. Related: All topics, Changing treatment.
What are the differences between Delstrigo and Symtuza – is one more effective than the other?
Answer
Hi, how are you doing?
Delstrigo and Symtuza and both single-pill combinations used to manage HIV-1. The difference between them is what medications are used to make them.
Delstrigo = doravirine, lamivudine and tenofovir DF. Symtuza = darunavir, cobicistat, emtricitabine and tenofovir AF.
Different studies have looked to identify how effective each of these drugs are. There is no study which directly demonstrated which is more effective by direct comparison. With undetectable viral load as the goal, a study compared Delstrigo vs Atripla in 728 patients. In 48 weeks, 84% of those on Delstrigo achieved this goal whereas 80% of those on Atripla acheived this.
A similar study used to identify the efficacy of Symtuza involving 153 patients was conducted with undetectable viral load as the primary endpoint. Over 24 weeks Symtuza acheived undetectable viral load in 75% of patients. This compared well to the control achveing undetectable viral load in 74% of patients.
As the timeline of each study differs a direct comparison cannot be made however they have both been demonstrated to offer equal or superior effectiveness in attaining undetectable viral load.
A major difference of note is that Symtuza is ‘boosted’ while Delstrigo is not. This means the combination of Symtuza contains an extra medication to boost how effective another drug is. In this case cobicistat boosting daranuvir. Boosted combinations are generally less well tolerated by people than other options available.
Both Delstrigo and Symtuza are not recommened as being first line. Instead they are both available as switch options. Meaning that when someone achieves undetectable viral load on their current regiment, they are able to switch to either of these. This switch factoring in adherence, access, suitability and cost.
Josh.
Hi Don, can you tell me what your CD4 count was for each of the treatments you have been on and what your viral load was each time?
Switching treatments when on a stable regimen should not lead to an increase in viral load and/or a drop in CD4 count.
Did your CD4 count still remain in a healthy range (430 – 1690)? and even though this appears as a small increase, any value under 50 is still considered undetectable for viral load. Small changes are normal and expected.
Were you ill/had a vaccine when you had these changes in the test results? In these cases you should wait at least 4 weeks before testing due to receving falsely elevated results.
And do you know your CD4%? This can give a more accurate representation of your immune system instead of the actual CD4 count. This number can change depending on the type of day or if you have exercised.
How are you finding your new treatment, Juluca? and how long had you been taking Biktarvy before you were switched?
I was on Atripla for years..I was switched to Biktarvy. My VL fluctuated since the switch. Now I’m put on Juluca.. VL went from Undetectable to >27 cd4 count dropped 100. Any suggestions. I have never missed a dose..
Plus juluca meal requirement is a pain