Thanks, very good post. Some of the trends in Viracept prescriptions 'kind of' goes along with this release below.
ONE IN FOUR PEOPLE STARTING TREATMENT FOR HIV ARE NOT TREATED ACCORDING TO US HHS HIV TREATMENT GUIDELINES
The Harris survey showed that a high proportion of women and minorities receive care inconsistent with Guidelines.
NEWS from SFGH/UC-San Francisco
Date: 3 Jun 1998 12:13:12 -0500
The results of the first National HIV/AIDS Treatment Survey released today showed that 1 out 4 patients are not treated according to the therapy recommended by the Department of Health and Human Services Guidelines issued in November 1997 as well as with HIV treatment guidelines issued by the International AIDS Society (IAS) of the USA. This was announced by John G. Bartlett, MD, Chief, Division of Infectious Diseases, Johns Hopkins University and by Paul Volberding, MD, Professor of Medicine, AIDS Research Institute, University of California at San Francisco, Director, UCSF AIDS Program and Medical Oncology at San Francisco General Hospital.
"Not suppressing viral replication to the greatest extent possible means that patients are more likely to experience symptoms of HIV, and their risk of developing an AIDS-related infection may be increased," said Dr. Bartlett.
"The survey results specifically showed that physicians with the least experience treating HIV waited longer to begin treatment and prescribed fewer medications than recommended in the guidelines." Women and minorities tended to see the least experienced physicians and were more likely to start treatment later, when they were already HIV symptomatic even though the guidelines recommend therapy before symptoms begin. 36% of women, 42% of African-American and 43% of Hispanics did not receive treatment until their viral loads were very high and their CD4 counts low, compared to 27% of white men.
Physicians with the most experience in treating HIV more consistently prescribed according to the guidelines. Eighty-eight (88%) percent of physicians with the most experience were most likely to prescribe a therapeutic regimen containing at least one protease inhibitor, compared to 60 percent of those with the least HIV-treatment experience.... physicians with more experience prescribed more than three medications for their treatment-inexperienced patients at the initial visit, compared to those physicians with the least experience who prescribed an average of two medications.
There have been dramatic declines in the death rate since June 1996, attributed to the use of protease inhibitors added to therapy with reverse transcriptase inhibitors. However the death rate for women has declined only 13 percent since 1996; the death rate among people of color decreased by 19 percent; and the most significant decline has been in whites (males?)- 33%
"Several organizations are actively involved in addressing the concerns raised by the findings of this survey," according to Dr. Volberding. "The IAS-USA sponsors numerous HIV educational programs nationally and the IDSA is creating the HIV Medicine Association." This disparity in the treatment of HIV "signals an urgent need to educate physicians and patients more aggressively on the guidelines for people with HIV," said Dr. Volberding, "and supports recent plans to create an HIV professional society." Physicians who receive information and education on an ongoing basis are more likely to adopt and apply these treatment guidelines," said Dr. Volberding. Patients familiar with the treatments and their options are more likely to seek and receive the most aggressive care.
This "news" is not too surprising. Peter Singleton posted a good article on the same topic March 3rd: Message 3586943
> Study results appeared in the March issue of the journal "AIDS"
>showed that Women with AIDS Found to Have 50 Percent Better Chance of Survival >When Treated at Clinics with High Levels of Experience in Advanced
>HIV Treatment Than at Less Experienced Clinics
>at least we have data confirming what Izzy and JLL have been saying all along .
It must be difficult even for HIV specialists to keep up with all the new HIV research; new drugs in expanded access; newly approved drugs; drugs in the pipeline and research on immune based therapies, integrase inhibitors, chemokines, vaccine developments; and changing recommendations in the Guidelines for therapy so these proposals to improve educational programs for physicians treating HIV positive patients are welcome and important, if they are implemented soon. Still, patients need to stay well informed and try to get care from Infectious Disease Specialists and/or physicians experienced in treating HIV positive patients.
It is not surprising then that ALL's summary of Agouron's presentation at the PW conference noted that physicians with the highest concentrations of HIV patients (presumably more experienced) prescribed more Viracept than Crixivan. Physicians not specialized in HIV prescribed more Crixivan. However Viracept had a lower market share among whites than Blacks and Hispanics.
Sustiva lowers Fortovase levels by 61%
Dr. Gallant's Patient Forum has posted some information lately about Sustiva (DMP-266; Efavirenz) interactions with Fortovase hopkins-aids.edu
Go to RECENT QUESTIONS on the patient forum, May 21st.
Sustiva lowers Saquinavir levels by 61% and Dupont now recommends that Sustiva not be taken with Fortovase or combinations such as Ritonavir/Fortovase or combinations of Nelfinavir/Saquinavir.
Sustiva increases the level of Nelfinavir (Viracept) by about 20% and no dosing changes are necessary when Nelfinavir is used with Sustiva alone.
Sustiva lowers the level of Crixivan by about 20% and Dr. Gallant says that Crixivan should be given at 1000 mg every 8 hours with Sustiva.
Dr. Gallant recommends that patients taking Ritonavir/Fortovase with Sustiva double the dose of Fortovase to 800 mg twice a day.
All this data is being studied. When Fortovase is taken with Ritonavir, only half of the dose of Fortovase is required -400 mg twice a day instead of 800 three times a day. Doubling the dose of Fortovase if it is taken in combination with Ritonavir and Sustiva may make it a little less attractive, as there are more pills and side effects may increase.
In March, Dr. Gallant mentioned that he hadn't used Fortovase as a single PI yet because it involves taking 18 pills per day in three doses and there is no long term data yet.
Dr. Gallant said that many people were switching to Nelfinavir 1250 twice a day, even though it was not officially approved yet. (category=protease, March 9,98)
>But what is spurring AGPH to put out the kind of press release>
Agouron did not issue this press release -
"Agouron Sees NDA for AG3340 Cancer Drug in 2000."
That was a Dow Jones release, by Louis Hau; the article is in the WSJ. There must have been a reporter at the PW conference.
>If the 3/98 earnings/share was $0.41, then why is the consensus >estimate for the 6/98 >quarter only $0.20/sh?
Estimates for Q4 6/98, are $0.26 from First Call, with a range of $0.23 to .31.
Zacks has an average of $0.20 for Q4 with a range of .20 to .31.
The First Call Report is very recent, 5/26? or 5/29 and I don't know what the date is for Zacks estimates.
The Q3 quarter included a one time milestone payment of $0.22 from Roche for Viracept approval in Europe and Japan.
Taking off the milestone payment of $0.22, means the 3Q was $0.19,
compared to $0.15 for Q2.
So $0.26 or higher for the 4th quarter ending June '98 would be impressive.
I think that NationsBank Montgomery Securities raised their Q4 estimate from .20 to .23 about a month ago. They were the lowest.
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