Health - When progress comes at a price… by destinationsante.com

When progress comes at a price…

[11 August 2009 - 10h17]
[mis à jour le 24 August 2009 à 18h02]

First line, second line, third lin... the arsenal of antiretroviral treatments to combat HIV just goes on growing as advances are made.

The most recent class of therapeutic drugs, integrase inhibitors, has given rise to considerable hope... and widespread research. Their use deep within the reservoir cells where the virus conceals itself has so far proved ineffective but its use in the first stages of treatment – first line treatment, in fact – appears to be promising. A poster at the 5th International AIDS Society (IAS) Conference held recently in Cape Town, South Africa, and an article in The Lancet a few days later, have aroused attention. But we mustn’t get carried away…

In both cases the writers compared the results of a “conventional” first line treatment – of which the third component was either Efavirenz (Sustiva®) or Raltegravir (Isentress®). At the IAS meeting, Eduardo Gottuzzo of Peru presented a study involving 198 patients with a monitoring period of close to 3 years (44 weeks). The results were favourable, leading to an effectiveness rating comparable for Raltegravir compared with the reference treatment, and with an improved tolerance.

The figures put forward by Jeffrey L Lennox (Emory University School of Medicine, Atlanta, USA) in The Lancet are also encouraging. Of the 563 patients monitored over 48 weeks at this stage of the study, half received Raltegravir and the other half Efavirenz. This was a representative trial which included a wide variety of patients from 67 different centres across 5 continents. The researchers conclude that there is very comparable effectiveness with viral load undetectable in 86% of patients on Raltegravir, 82% with Efavirenz. These results were obtained more rapidly with the first group, with 50% suppression observed by the 4th week, compared with 20% in the case of Efavirenz. And again, the results argue in favour of a better tolerance of the integrase inhibitor, with “only” 44% secondary effects compared with 77% for patients in the other group.

The researchers, supported by an accompanying editorial in The Lancet, see these results as suggesting that Raltegravir – and other integrase inhibitors – might be raised to the status of first-line treatment. This would be a major change as these products are currently reserved for use with patients in multi-failure. At the Cape Town conference, however, opinions varied.

Professor Jean-Michel Molina of the Saint-Louis University Hospital, Paris, agreed that this new class of therapy was indeed of interest. It already includes two products, with a third soon to follow. This has been seen as “very interesting because it has a long half-life with good short-term effectiveness”. It will be a welcome addition to a “promising” family of drugs. Professor Molina’s enthusiasm is, however, cautious, as he recalls that these molecules “are currently reserved for use with multi-failure patients. If tomorrow they were to be prescribed much earlier – and much more widely (ed. note) – their exorbitant cost – 800 euros per month of treatment – would not be justified. We have others just as effective that cost much less, even though the treatment is a little better tolerated”.

Source : from our special correspondents at the 5th IAS Conference, Cape Town, 19-22 July 2009; Dr E. Gottuzzo; interview with Pr J-M. Molina, 22 July 2009; Dr Jeffrey L Lennox, The Lancet, 2 August 2009.

>> Cet article est aussi disponible en français

© 1996-2010 Destination Santé SAS- All Rights Reserved. No information contained on this server can be reproduced or retransmitted without prior written consent of Destination Santé. Offenders will be prosecuted in consideration of articles L 122-4 and L 335-3 of the Code of Intellectual Property, allowing up to two years' imprisonment and a 150,000 euros fine.