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



Omnibus at the Salpatrière!

By Charles-Edouard!

It's going well for our friend Joëlle:

First of all, we're happy for you, and as far as medical follow-up goes, look what happens:

Charles-Edouard! and OMNIBUS at the Salpêtrière

The excellent seminar at Pasteur gave us a boost. As ANRS-4D has a 100% success rate in compliant patients, what can Quatuor bring if not a confirmation? At worst, there will be some failures, but so what? We will be able to better circumscribe the eligibility... The procedure is 100% risk-free. We already know that it is 100% without damage or after-effects: a simple return to 7/7, with the same combo, is sufficient, without prejudice.

Quatuor has a mandatory checkpoint, in a few weeks. They are going to publish an intermediate assessment to authorize (or not) the candidates who have been willing to stay in the delayed arm (7/7) to switch to 4/7. We will then know how many patients, in the 7/7 arm, have sent the ANRS packing by switching, on their own, to 4/7, since it is... authorized by Morlat!

The whole of Paris that counts expects excellent results. In particular, the Salpêtrière, which has provided the largest contingent, and therefore has a good idea (patients and practitioners know which arm they are in). Quartet or not, we have the wind in our sails, and it's not to go in circles!

Leibowitch considers himself out of the game because of his age, and wants to pass the baby on. In order to give credence to this retreat(do you really believe it?), he has effectively worked to open up a presentation opportunity for us at the Salpêtrière. The echo of our success at Pasteur comes back to sensitive ears.

So here we are, invited by Pr. Eric CAUMES, to a presentation, a staff, on Thursday 27th. We don't have long to convince, but we start to be a bit broken in.

Between the initial plan, the modifications of summaries, the slides reviewed, then corrected, then rewritten, the rehearsals, it took us 4 full days to work on it: the public and the stake are not the same!

ICCARRE is a clinical concept. At Pasteur, they are a bit virginal, but not at the Salpétrière!

A large audience

A presentation by Leibowitch, that attracts! And there, you had the bench and the back bench of the whole Salpêtrière, clinicians, virologists, interns, externs, employees of the industry(sic). In short, it was anything but intimate. If some people had come for the clash, they still got it, a little!

We had come with our die-hard supporters, and fortunately! We were playing outside. On the Salpé side, at least fifty white coats: it's the biggest hospital and university center in France! (of Europe?)

Well, for the atmosphere, let's say frankly that we were received with professionalism and courtesy. This is important because the debate was intense, and the firm organization of the speech a perilous exercise and, let us say it, successful.

Presentation in three parts: Leibo, Ch-E, Leibo

The presentations will be online soon. You too will be entitled to the content.

Leibowitch started with a trick: he won't say a word about 4/7, it's a done deal, and that's not the point. He presents his clinical cases: there are a good fifty patients at 2/7 (including twenty at 1/7). That's a good picture!

Then he passes the floor to me for a mini-presentation: Dynamic Remission and Omnibus: Showing that the Eclipse exists, its dynamics, introducing dynamic remission and the (new) notion of Distance, OMNIBUS and our projects.

As you will have the slides and the topos, I won't go into too much detail... OMNIBUS? It's a validation test of the 2/7 followed by an exploration of the best synergies.

Then Leibo takes the floor again to make the case that it's time for distinguished clinicians to take over. At almost 85 years old(he says... ), he wants to pass the baton. So it's up to you to step up to the plate.

A passing exam

The reader must understand that we are dealing with experienced clinicians. You mess up on an argument, and you're finished... I know my subject well, but not everything, and they ... Yes, I do...

I mention the Visconti... And then Prof. Katlama interrupts me to ask me to define what the Viscontis are, in case there are people in the audience who don't know. Well, I'm doing pretty well, and I'll put the nail in the coffin: all attempts to recreate Viscontis (e.g. SPARTAC trial) have failed. As in the circus, the gladiators test themselves.

Small point of semantics

I mentioned that from now on we would call 'dynamic remission' what is at 1/7 (or even better), and nobody noticed... It seems to pass.

Since there are now so many proposals on the table, it was agreed to call from now on what has less molecules and intermittence, the x/7. Yes, because otherwise it is confusing! We learn, in passing, that the Salpé has about fifty patients on Mono-DTG, without any problem...

A lively debate, stormy at times, and an ultra positive conclusion

Under the firm direction of Prof. Caumes, Prof. Katlama takes over. Well... She is in front of her troops, so she paints us a pro domo picture, where the Salpé is portrayed as a proactive actor: 1/3 of patients are on lighter prescriptions. Well... We came to give the keys of the city to Caesar, so it's in the right order...

There are still some who are bothered by ICCARRE-le-Grand. Virology is the first one to shoot, and the reservoir's patati and patata. I'm taking out my public challenge: prove, by a contingency table, that total DNA is a predictor of the Eclipse's closure. I know there isn't one... But then, Katlama, reports that in MONOI there was only one real failure, but a few blippers, in whom there was a small reservoir effect, which is normal and expected, according to her.
No need to raise. That doesn't answer my challenge... Especially since she could have used her ULTRASTOP test, which she didn't do, and which reinforces my idea that there was little argument to be found there... Huh? Well... Now we've kicked you out of the total DNA with a big kick in the pants.

Roland Tubiana noted that I had presented advantageous openings of the Eclipse, measured in very early treated patients, with low reservoir. This is factually correct! We don't point out, because in fact, we can't do anything about it... The tendency, among the few clinicians who do analytical interruptions, is to choose favorable patients a priori, so as not to get too bored... We don't have recent values on 'broken arms', but we have 20,000 weeks at 2/7 (or even 1/7)! That's 20.000 eclipses, of at least 1 week, repeatedly!
So as long as the eclipse is of more than one week, whether it is of 7, 15, 21 days, we don't care a bit, for the subject of the day.

Then he laid out a known speculation, that even below the threshold of undetectability, things might be happening and that, well, there you go, that might sustain some replication and inflammation, what do I know.... What do I know, indeed... It's Nessie, the Loch Ness monster, we've never seen anything, never proven anything... It is purely speculative...

So it's a bit annoying, for nothing... But well... Leibo, he likes to show off, and the young interns who dreamed of a clash have been served. It's even better than at Bourdin or Ruquier. And then, it was the language of a rifleman! Well... Let us pass...

In fact, the bottom line is that Katlama, the story of an OMNIBUS trial at 2/7, likes it... That's it! We had plenty of marbles, arguments, pleas, but, in fact, useless: OMNIBUS pleased!

We had presented it in broad strokes, so she asked us to refine our project.
That was all! It lasted an hour, and it was agreed that we would refine OMNIBUS, and follow the usual path.

A success... I'm proud of it!

For a success, it is a success. Since it was bibi who presented it, I was a bit surprised: it went through like a charm(well... it will do... ). Well, after 4 days of preparing a nice shot in the cage, it took me 3 days to recover!

I'm exhausted... More in the next issue!

Have a good weekend, good stuffing and not too many meds... Right?