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Sunday, February 11, 2018

Mono-DTG: an all new VICTORY

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

Mono-DTG: an all new VICTORY

By Charles-Edouard!

Lanzafame: Total success in Mono-DTG maintenance

Dolutegravir tivicay monotherapy lanzafame cure hiv cabotegravir
Lattuada, Lanzafame et al. publish 25 maintenance patients under Mono-DTG: Dolutegravir monotherapy in HIV-1-suppressed patients: A feasible regimen in real life

ZéRo failures!

Like us, Dr. Lanzafame identifies Achille's Heel and good adherence as a criterion. The theoretical failure rate, based on the 125+ patients of BMM + P, is 1-2%. They do as in our Mono-DTG practical guide and have no failure:

This is the first post-BMM + P and post-DOMONO report: those who predicted the total failure of Mono-DTG are busted! (and nobody tells you about it...)

More than 200 patients in success under mono-DTG!

3 years after the approval of Tivicay®, we already have more than 200 patients in success (100+ in BMM + P, 50 in DOMONO, 25 in maintenance and 25 in first line at Lanzafame). The DOMONO authors offered the 61 patients, in success under Mono-DTG, to return back to Tri. The sneers chuckled! Except that ... 59 simply refused! Faced with a supposed, possible and undifferentiated risk, 97% of patients refuse to leave Mono-DTG: they do not believe it!

Here is an interesting pool for the partial, even total, remission a little like the Viscontis!

Mono-DTG and short cycle: 4/7

Subject to the selection criteria (genotype on INI), mono-DTG is an absolutely acceptable first-line treatment, and therefore a good candidate for the ICCARRIAN descent. We could redo the very first trial: 7 days ON followed by 7 days OFF.

In our new survey (top left): all voters think that under effective Mono-DTG, we could cycle. 3 arguments are in favor of a doses reduction: pharmacokinetics, Cabotegravir at ... 30 mg, pharmacodynamics.

Pharmacokinetics are Permissive: use it!

A study, by Elliot et al., funded by ViiV (hi, hi, hi ...) shows that DTG has a more interesting profile, more permissive, than EVG. It shows, above all, that DTG remains above its IC90 (64 ng / mL) more than 72 hours after interruption. They explain that the pharmacokinetic persistence makes DTG a good candidate for FOTO or BREATHER sequels.

pharmacokinetics monotherapy Dolutegravir tivicay elvitegravir genvoya skip dose

Cabotegravir 30 mg or Tivicay ® 25 mg (1/2 pill)?

Lanzafame does with what is available: Tivicay® 50 mg. Soon, Cabotegravir 30 mg will be available. Will he try, tomorrow, CTG 30 mg in maintenance? Why would he not?

But, here ... We know that CTG and DTG is six of one and half a dozen of the other. CTG is not yet available while it is already technically possible to use DTG 25 mg (1/2 pill).

Eclipse and delayed effect

Under effective and truly effective treatment, the Eclipse exists for everyone: it is a fundamental and foundational Anti-RetroViral feature, not an anecdotal performance. The effect of pharmacodynamic remanence under Mono-DTG (and Mono-Bictegravir, for that matter) is known since the ING111521 trial.

Dolutegravir, Absolutegravir, remission and medical malpractice

At the turn of the century, remission attempts, with inefficient molecules, had failed. Dolutegravir is a game changern: for many patients / viruses, it is an Absolutegravir. In monotherapy (perhaps not in tri ...) it opens an opportunity for total or partial remission.

The patient who starts RAL or EVG as first-line or in maintenance (if there are other options) makes a serious and potentially adverse decision to her legitimate hope for remission.

Likewise, the patient, under effective Mono-DTG, who would close her eyes on ICCARRE, deprives herself of a potential remission, at least partial.

Well ... we can say THANK YOU! to Lanzafame and the team of Verona!

In the news

- The variety marchants did not appreciate the prospect of a weekly drug, but then there, not at all and let it know!

- The statineur cardiologists did not appreciate the rebroadcast of ""Cholesterol: the Big Bluff". Their argument (link): alarmed (see here), many patients have stopped medication and a study will prove excess mortality: Professor Moore (Bordeaux) announced such a study more than a year ago, and since then it's total silence! There is a world between announcing a study and prejudging its result! A truebluff! Statins: The Great Pshiiiit?

- Irene Frachon explains the basics of corruption . Uplifting!

- Prescrire publie sa liste its list of authorized but dangerous drugs

- Hepatitis B: vaccination for subjects at risk: to be considered; for all infants: an ineptitude. Marc Girard dissects how we got there. Read here too. Brigitte Autran sheds another light.

Have a good Week, good fuck and do not abuse of meds/drugs

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