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Sunday, September 17, 2017

Mono-DTG: all is fine

Summer 2016: we offered a serial: ANRS-4D and the cheaters

Summer 2017: we will debunk DOMONO:
- Dolutegravir and R263K
- R263K: new scenario (DOMONO)
- N155H: new scenario (DOMONO)
- Nevirapine and Mono-DTG Switch: the Hunchback Trap
- calculation error in the primary hypothesis
- DOMONO and the benefit for the patients (not for BigPharma ...)

This was originally published here, in French. We provide this translation for your convenience, practical aspects may differ where you live.

Mono-DTG: a winner

By Charles Edouard!

In DOMONO, we will find the same failure rate as in BMM + P. Mono-DTG is of little interest to us. In a 1/7 perspective, based on Tivicay®, it can serve as a preamble to a remission strategy. Indeed, if one succeeds in Mono-DTG, one is perhaps in favorable conditions for the ICCARRE descent, either in Mono-DTG or in Bi (BiCycle strategy).

The DOMONO trial overrides proper selection and advice for better bioavailability!

Your Mono-DTG chances can be greatly increased with our Mono-DTG Practical Guide.

No harm to patients

As for the failures in Mono-IP (strategy to be avoided), a viral escape is clamped down by simple return to the initial triple therapy. Patients who fail will have, at the most, to go back, where they were already. And for those who succeed it is just so cool!

In all participants, ART was reinstated and CV was <50 within 12 weeks in all! (see here). The authors of DOMONO (results here), and BMM + P analyze that the attempt at Mono-DTG results in no loss of therapeutic option. And that's what counts!

HUGE benefit, except for ViiV Healthcare

We must admit that, for the time being, the idea of ​​a cyclical strategy (eg 4/7) does not make a good impression on people: they do not understand it, they are suspicious of it. The septists are septists to the marrow, to understand the Eclipse will be difficult for them. At the same time, the desire to take better care, with less, remains very strong: a bi or a Mono-DTG can be an intermediate solution.

The real prejudice is for those who do nothing, and stay in TRI ad vitam.

My readers testify: Mono-DTG is a real relief! I confirm!

A reader reminded me of the benefit when s/he went from Stribild® (4 molecules! And meal obligation) to Mono-DTG, so easy, so small to take, and, above all, so much better tolerated!

What to say to this 72-year-old patient, diagnosed late, with other health problems, CD4 = 1 (!), treatment naive , and that Dr. Lanzafame put under Mono-DTG, successfully? What to tell him? That he should have taken an infamous TRI, then wait a year before doing an ICCARRE descent (as if it were proposed to everyone!). Of course this patient is happy... Because seniors, under 5 ARV molecules, do exist!

Nevertheless, the patient has a choice! Just ban Mono-DTG because of a poorly run trial is ridiculous! Those who have been opposed a rebuke (read here) go elsewhere and they are right!

DOMONO is a useless trial, just good for the trash

It is a bad attempt, not just because I find the conclusion ridiculous and its interruption unjustified, but because it teaches us nothing ... Nothing at all ...

Where is the post-hoc analysis of the Achilles heel (yet incontestable, cf BMM + P)?
Where is the phenotypic (not genotypic) test for patient # 1, as promised in Oct. 2016?
Where is the critical analysis of mutations? And to forget that the R263K is beneficial ...

Ah ... We could identify the Hunchback trap... Well... We?... It's I ... Not the authors ...

Where is the benefit / risk analysis while the benefit is enormous? And the prejudice nul?...

Mono-DTG, it's still a so much better than MONO-IP! (strategy to be avoided, for that matter)

Practical Guide Mono-DTG

The Practical Guide (4/7) has moved the lines: it is copied here or there, and the Morlat recommendation boosted it well beyond my expectations

So I am writing a Practical Guide for Mono-DTG, confident that Morlesque oukase, will go, like DOMONO, to the trash.

Bicycle and MonoCycle Strategies

The Eclipse equation is valid in an efficient medication context, without imposing that it is a TRItherapy

The Eclipse exists whenever the treatment is effective. It does not prejudge "synergies" (there, one will have to explain me the whys and hows ...). The Eclipse results from a burial phenomenon (we'll get to this soon ...) that DTG promotes.

The Eclipse Equation, the deep burial of the proviral sequence, is been worked on, and we can begin to consider a long eclipse for all.

Today, there are enough individual testimonials of success under Bi or Mono-DTG cycles, to be interested in the issue. Especially since the Septists, anti-ICCARRE in their genes and interests, will soon jump on DTG + 3TC or DTG + RPV to lock their patients again in their everyday life straitjacket.

The temptation is too appealing in their camp: it is also in ours!

When you have an Eclipse (and who does not?), why not take advantage of it?

We evacuated DOMONO, that the Medico-Pharmaceutical Zealots will thrive on. Let's put this bad trial to the trash ... Too happy that we have learned some lessons, and better armed to resume our path to remission (refueled, of course...) by integrating this modern and relevant tool: DTG.

In the next few weeks, I will outline what a BiCycle Strategy would be (DTG / x in 4/7, 3/7, 2/7, 1/7 ...) or even MonoCycle (that then rejoins HypoDolu)

These many years to observe the inanity of ANRS convinced me that one does not enter the remission path by kowtowing rue de Tolbiac. Adios non-amigos!!!

We'll resume our normal schedule... Good Weekend, good fuck, not too many drugs, huh ...

1 comment:

  1. A nov.13 comment on this page has been moved to the French version, since this comment is in... French. Proper translation will come soon