Achilles heel

Achilles heel
This paper was originally published here, in French. We provide this translation for your convenience.

Breaking news: I will soon publish the first results obtained with Tivicay ®, alone, in first line ... Bingo!... Bingo!

Certainly, there were rare failures, in some patients, but not just any patient! This is not 20%! Let's stick to data ... The risk is anything but random: it is limited to well discernible patients: those with a predictable weakness: the Achilles heel!

The Achilles heel

Catie discussed in the same issue and Genvoya® and Mono Tivicay ®:
http://www.catie.ca/sites/default/files/tu212b.pdf

Pr. Christine Katlama has drawn attention to the risk to undertake Tivicay monotherapy for patients who already made use of RAL or EVG, i.e. Isentress®, Stribild® or Genvoya®.

Catie presents, verbatim, in English and French, all known cases of failure in this strategy: they are few and well described.

I have presented in previous posts: 1 , 2, 3, and, the original slides are here.

Prof. Christine Katlama divides her 28 patients into 2 subgroups: those who have never taken nor Isentress® nor Stribild® (/ Genvoya®) (Group # 1) and others who have already taken one and / either (group # 2). Thanks to Catie's issue dedicated to Genvoya®, we can do some basic accounting:

In Paris (Katlama) :
Group # 1 Group # 2 + = 28; Group # 1 = 15 and group # 2 = 13
Failures in the group # 1: 0 (15)
Failures in group # 2: 3 (out of 13)
In Barcelona :
Group # 1 Group # 2 + = 33; Group # 1 = and # 2 = group? (But> 2)
Failures in the group # 1: 0 (over ?)
Failures in group # 2: 1 (of at least 2?)

Reading Catie allows us this simple accounting. Just read and count ...

When one is already in group # 2, knowing that there is an identified risk, circumscribed, albeit poorly quantified, and what to do is important.
When one is in group # 1, we can consider to stay there. At least for now.
I am in the group # 1, which appears to date, nice and interesting to preserve.

If you are in the group # 1, stay there ... So avoid Stribild® / Genvoya® at all costs.
The genotype does not help much. These tests were done in patients by Pr. Katlama (of course ...). None had had a previous failure with Integrase inhibitors. This is not an earlier failure that puts you in the group # 2 ... So none of these patients had no detectable, anticipated risk.

Only the patient's history is offered as explanation for the risk..

In group 2, there are three failures, but also 10 success. You can either see the glass 3/4 full or 1/4 empty ... In group 1, no failure ...

Understanding the Achilles Heel is important for all!

There are only two questions to ask oneself:

1 - Is Tivicay ® monotherapy possible, and if so... 2 - for maintenance, is 10 mg as good as 50 mg?

For those who have the Achilles heel, consider your options with care: 4 out of 5 patients are successfull; not bad!
For those who have not (yet) the Achilles heel: avoid it at all costs!
For those who don't have it and will safely move towards the mono Tivicay®, read this carefully: because the risk of failure was the consequence of mutations that you have been able to avoid, then, understand this: it is not because of the dose: the dose (50 mg) was revised upward for all (including those who have the Achilles heel), wheras you were not at risk! QED.

Upcoming posts: Tivicay® Monotherapy in first line, why avoid TruLight trial, how to wean antidepressants ...

Breaking news: I will soon publish the first results obtained with Tivicay ®, alone, in first line ... Bingo!... Bingo!

Have a good week and enjoy sex



This paper was originally published here, in French. We provide this translation for your convenience.