Multidrug-resistant HIV: After Trogarzo withdrawal, an update on treatment options

The TRT-5 CHV collective, a combined treatment and research therapy group, is interested in the future of care for people with multidrug-resistant HIV, while Trogarzo – the monoclonal antibody ibalizumab – will be withdrawn from the European market. collective
Denounces the law of profit in the pharmaceutical industry.

In a press release dated April 27, the biopharmaceutical company Theratechnologies announced that it would cease its marketing activities for Trogarzo in Europe and return the drug’s European marketing rights to TaiMed – the company that developed it – in the next 180 days.

“The rates and payment terms of Trogarzo in the main European countries were not satisfactory for Theratechnologies, The company regrets. Although Trogarzo is an important and effective treatment for people living with HIV-1, continued commercial sale of Trogarzo at prices and payment terms offered by various European governments would have resulted in continued losses for Theratechnologies. »

For its part, TaiMed indicated that it is too “Determined to continue marketing Trogarzo and provide the drug to patients who need it, we have already started looking for a new business partner for the European region.”

It has molecules with different mechanisms of action

Not enough to reassure the TRT-5 CHV that alerts: “The unavailability of Trogarzo in France threatens to exacerbate the critical situation in which patients find themselves while their lives and their care pathways are already very difficult.” Professor Jean-Michel Molina, an infectious disease specialist at the University of Paris and the Hospitals Saint-Louis and Lariboisie (AP-HP), regrets with “Quotidien”, “The public health interest conflicts with commercial issues.”

remember it Fortunately these multiple failures remain exceptional, affecting approximately 1 patient in 1,000. It specifies that in France, 12 patients treated with Trogarzo in the Early Access context since 2019. However, he continues, “These are complex and high-risk conditions that can progress to the stage of AIDS or death, with the risk of death being tripled in these patients.”. For a specialist, it is essential to have active molecules with different mechanisms of action to circumvent cross-resistance.

Lenacapavir highlights

In addition to Trogarzo, which has the drawback of being given intravenously every 15 days, some other molecules are available. For Professor Molina, lenacapavir, also available in Early Access, appears to be the most promising. “He showed anti-Widely in the laboratory Whatever the viral strain, because it targets the virus capsid, which is a high-preservation protein, and has the advantage that it can be taken in tablet form once a week or as a subcutaneous injection every six months, which has a great advantage in terms of compliance.he explains.

Capella’s phase III study, recently published in the “New England Journal of Medicine” and co-authored by Professor Molina, confirms the strong antiviral activity of lenacapavir against HIV-1 and its good tolerability. Lenacapavir may be more effective than ibalizumab in terms of antiviral efficacy.specifies the infection specialist, stressing that these new findings should lead to the prospective marketing of lenacapavir.

Fuzeon (enfuvirtide) has been available since 2003. “While it is interesting due to its mechanism of preventing fusion between the envelope of the virus and the target cell, its use has been gradually reduced due to a complex method of administration, with two subcutaneous injections per day, causing nodules.”Professor Molina explains. As for Rukobia (fostemsavir), which received marketing authorization in early 2021, its main advantage is that it is available in the form of extended-release oral tablets.

“If all of these drugs have rare indications, it is essential to maintain access to these patients in risky situations.”The infection specialist insists, adding that these treatments can also be combined. Thus, in the International Capella Study, which included a total of 72 patients, 24% of patients were received, in addition to lenacapavir and Trogarzo, 11% of Rukobia and 7% of Fuzeon. Altogether, more than 80% of the patients in the study were virologically controlled.Professor Molina reports.

* A group of associations fighting HIV, hepatitis and sexually transmitted diseases around clinical research challenges and therapeutic advances to advocate for the interests of the people involved

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