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Saturday, January 6, 2018

Mono-DTG: conflicting meta-analyses

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

Mono-DTG: conflicting meta-analyses

By Charles-Edouard!

News from TRITOMAN:

Super! Nice to hear from you! Yes ... I really think we are on the right track. You see we are now a good little fighting group. Ah! It's really fun! We progress slowly, and well! Best wishes!

Meta-analysis? Meta-what? Meta-who?

Some studies overlap ... To obtain the power of numbers, we would like to aggregate them. When I draw a table of observed Eclipses, in different small studies, I do a metanalysis. (note, I have 3 to add ...). When Dr. Blanco discusses BMM results (Barcelona + Munich + Montreal), at CROI 2017, he does a metanalysis. I add Paris, thus BMM + P ... We sometimes loses the specificity of a study, but gain in number.

In the radio program 'the scientific method', Anne Georget and Dr de Lorgeril, who demonstrated the deception in the Jupiter trial, explain that results depend on the studies retained for the meta-analysis, that meta-analyzes funded by Big Pharma are, by chance, favorable to them: they will be cited ad nauseam, so to make us forget other studies which are unfavorable to them.

Daelig: An educational Pharma-fiction

What follows is an educational pharma fiction. Glioblastoma is an abominable brain cancer. The KSG group, out of solution, buys a 'miracle' molecule, Daelig, which cures glioblastoma in no time. Remission for all, at the cost of a small maintenance treatment. The most pro-active clinicians are launching pilot studies: initiatives are proliferating. A big study, GLIOMONO, blind, is launched. Let's go. Meanwhile, a small Parisian study, shows an unexpected thing: the right-handed patients heal, but not left-handed. In small studies, we have failures but only with left-handed: right-handers are 100% successful; left-handers, failure every time (it's a fiction, so itI made it simple ...).

What do you think of Daelig? It's great or it does not work? You have a Glioblastoma ... Are you trying Daelig?

An academic meta-analysis, excludes GLIOMONO (blind study) and separates right and left handed: it concludes that it is great, subject to initial sorting. A meta-analysis, funded by a competing lab, blithely mixes everything and concludes, conversely, that Daelig is risky.

Easy to understand, no?

Mono-DTG meta-analyzes: Marta Buzzi vs. José Moreira

The first meta-analysis is from José Moreira in Journal of Antimicrobial Chemotherapy: Dolutegravir monotherapy as a simplified strategy in virologically suppressed HIV-1-infected patients.

It concludes the possibility of Mono-DTG, after an initial selection (Achilles heel and compliance). Dr. Blanco presents tables which necessarily lead to the same conclusion, without explaining it. Why does he not explain that he has identified the rules to follow to succeed Mono-DTG? Well imagine that he did and offered a presentation on rules to follow to succeed with Mono-DTG: it would not have been accepted. Rejected by the selection committee, in the same fashion as the Leibowitch's presentation (800 years of remission ...) was rejected by the steering committee, itself driven by ... By naming his presentation: resistance in BMM, Dr. Blanco had managed to make himself acceptable to the paid Guardians, anxious not to offend the 'sponsors'.

José Moreira Blanco monotherapy dolutegravir meta-analyse CROI-2017 DOMONO
By presenting the 'acquired resistances' he will have succeeded in presenting us with the rules to follow in order not to have any ... Diabolical and effective.

On the other hand, it was in the interest of Big Pharma to do have a meta-analysis that would show the impossibility of Mono-DTG: the recipe is simple: amalgamate everything, without distinguishing risk factor. Exactly as in our pharma-fiction: if we mix left-handed and right-handed, and what is a great molecule, appears much less so.

This is made easier by the DOMONO authors (DOLUMONO) who refuse to identify patients at risk, preferring to kill their beloved strategy, rather than admit their gross methodological error: ignore factors of risk made obvious after their trial start! This is where protocolism leads to.

The amalgam: an arch-known recipe

Alexandra Calmy Marta Buzzi monotherapy dolutegravir meta-analyse EACS-2017
The recipe is well known (and I had denounced in advance ...), we just had to wait for the first moron, who would have an 'interest' in 'demonstrating' inferiority, undern any circumstance, of Mono-DTG. Sorry, we had seen it coming!

Opportunity makes a thief: Alexandra Calmy and Marta Buzzi launch a trial: Evaluation of a Simplified Strategy for the Long-term Management of HIV Infection (Simpl'HIV) NCT03160105: it is a DTG / F-3TC dual therapy trial.

As a trial is a hypothesis test, I challenge you to identify the hypothesis without laughing. What is certain is that it will goes right in the hands of Big-Pharma, and authors do not take an excessive risk: the DTG + 3TC strategy has already been amply validated, including as a first line treatment! (LAMIDOL, PADDLE and ACTG A5353 trials).

Here again, Swiss medicine leaves us speechless, and does not shine with initiative: a meta-analysis completely stupid, as a premise of a clinical trial that is even more!

Obviously, no actor of the French, German, Italian or Spanish medico-pharmaceutical mafia would have dared! They would have been ridiculed by their best clinicians. So, they waited, in hiding, that one commits an ineptness worthy of firing a freshman!

Charlatans of an imaginary risk, the Diafoirus are delighted to quote their new do-not-think-master, to the delight of Big Pharma and sneers, who are not fooled! Check your favorite media: you'll see the replicative power of organized lobbies.

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

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