Magazine article Drug Topics

Non-Nucleoside Drug Newest Weapon in AIDS War

Magazine article Drug Topics

Non-Nucleoside Drug Newest Weapon in AIDS War

Article excerpt

The armamentarium for HIV/AIDS just got larger with the Food & Drug Administration's approval of a new non-nucleoside reverse transcriptase inhibitor. Rescriptor (delavirdine mesylate, Pharmacia & Upjohn), in 100-mg tablets, will likely be used in combination with other anti-HIV drugs and is expected to be widely available by early May, according to Goran Ando, M.D., executive v.p. of Pharmacia & Upjohn.

And just where will this new drug fit among the widening variety of options now available? "It's another drug that will attack the virus in a different way," commented Elliott Goldstein, M.D., professor of medicine at the University of Kansas, who participated in clinical trials of the drug. The non-nucleoside reverse transcriptase inhibitor joins nucleoside analogs and the protease inhibitors in attacking the virus.

"I think it's going to be very useful in patients who are on triple therapy, where we've already used AZT and 3TC and they've not done well. Therefore, one would be using Rescriptor with a protease inhibitor-say, with stavudine or D4T," said Goldstein. "One good thing is that when you use Rescriptor, you increase the concentrations of protease inhibitors like Crixivan, so it gives a nice boost to the protease inhibitor." He added that it could also be used in patients with primary infection, "although more data will have to be obtained on using it initially along with AZT or a protease inhibitor."

Goldstein also found that "people did very well as far as safety went, except for a rash, which they got in the beginning. But the rash went away in every patient." Clinical trials in more than 2,400 patients, begun in 1994, showed that treatment in combination with nucleoside reverse transcriptase inhibitors resulted in decreased levels of the virus in the blood. There was, however, no demonstrated effect on survival or on the occurrence of AIDS-related illnesses, according to the company.

Use of delaviridine can save utilization of the more expensive protease inhibitors, according to William Freimuth, M.D., Ph.D., a clinical researcher at Pharmacia & Upjohn. "Used in combination, Rescriptor increased the blood level of indinavir. …

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