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Biotech / Medical : Indications -- HIV
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To: DewDiligence_on_SI who wrote (82)2/21/2009 7:46:02 PM
From: Elroy Jetson   of 155
 
As the binding moiety of each drug is different, and the pathways blocked can be different, you don't need to combine a pyrimidine analog only with a purine analog.

In any event there are other analogs such as cysteine and thymidine. Intelence is an example of a newer thymidine analog.

The purine nucleotide Viread is a powerful combination with the purine nucleoside Didanosine. The unexpected effect was the increase in CD4 count is less than expected, with actual declines in those with high CD4 levels. I think this has been over-generalized into a problem in combining drugs with similar a analog structure.

The problem with this idea is new studies show the integrase inhibitor Isentress is inferior in head to head trials with Sustiva or a protease inhibitor, all three combined with a standard RT background therapy.

Studies show the integrase inhibitor Isentress with background therapy is equal to Sustiva but inferior to Kaletra. So a combination of an integrase inhibitor in place of Sustiva is possible.

In practice I don't see generous amount of value created by a single large tablet in place of several smaller ones, particularly since each pharma firm appears to find it necessary to substantially discount the combination tablet when compared with selling them individually. While there may be some cost savings in packaging and inventory, I believe much of the "popularity" of a combo drug like Atripla is an illusion bought at the expense of profitability.
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