This was originally published here, in French (link).
We provide this translation for your convenience. Practical aspects may differ where you live.
relief and intermittence
By Charles-Edouard!
This is the question everyone will ask... Almost everyone... Others will go for 3/7. It is the purpose of the OMNIBUS project to answer it. Reminder: this blog is not a medical advice
relief vs. intermittence
Since our Staff at the Salpêtrière (Sept. 2018), it is agreed to call lightening, which uses fewer molecules and intermittence, short and ultra-short cycles. Reducing the concentration of EFV from 600 mg to 400 mg (or even 200 mg) has no other name than 'correction of methodological error' .... Obviously, there are people who will want to do both ... Especially since the 4/7 in commercial dual therapy is inevitable... Inevitable, because the only advantage of MK-8591, the EFdA marketed by Merck is its half-life of ... 168 h! To think that the 4/7 in BI will not be done is a nonsense... It is quite legitimate to ask oneself, as of now, the question.
For carefully selected patients, MONO-DTG works very well, and I can assure you that it is very pleasant, since the tablet is very small. I have had it work in half (7/7) and quarter (7/7) tablets! I assure you that when you take your quarter of a tablet in front of a witness, she is amazed... Mono-DTG has a remanence of 3-4 days, it is written in the Vidal, and tested in the ING XXX trial; So people who succeeded in their Mono-DTG in 7/7, went to 4/7, including my excellent friend jesuisdutreize. The weak point of this strategy is that there is an Achilles heel if the virus has been treated, at some point, by RAL or EVG. For those whose virus is old (pre-2007), just look at the prescription history. For the new ones, it is a bit different, because their virus could have been treated (badly) by the person who gave it to them. However, we do not know how to make a relevant genotype for this case, so there is a random risk, all the more so since Isentress ® (RAL) was used liberally, as in Holland or in the West of France...
So, before considering a MONO-DTG in 4/7, one must be sure that one is on the right side of the handle... The passage by 7/7 is thus rather a good idea. It is necessary to be perfectly compliant during this first phase. Then you can work on intermittence, under close biological monitoring, as always. MONO-DTG in 4/7 is great. Today, in Paris, Prof. Katlama is the reference for Mono-DTG.
OMNIBUS-Bicycle
Then there is the choice of the second molecule (or not). The undeniable advantage of Mono-DTG is that in case of failure (apart from the Achilles Heel), there is no resistance to DTG. Let's say, in any case, that DTG can continue to be used. Martinez, Lanzafame, and personally, myself, believe that it is enough to reinforce, without making a cross on DTG: that's pretty cool!
3TC: In case of failure under DTG/3TC 4/7, the weak link is not DTG but 3TC, in other words the M184 mutation: this one is a pain... It is easily eliminated by fallowing (1 year off treatment) but you will be bored for the rest of your life and you can say goodbye to dual therapies, to 'classic' intermittence, etc... The objective of DTG/3TC in 4/7 is good if it works, and then what do you do?
RPV: better not to be susceptible to drug-induced depression... DTG on one side, VPN on the other, there are many who can't stand it. As always, if you can handle it, it does, and it's Juluca®, in one pill. If there were no alternative, it would be attractive.
ATV: This is the stuff we're talking about. The highest strength barrier is DTG and ATV is right behind it, so it's concrete. I'm very happy with it, no liver problems, and it's a good way to get to 3/7. Leibowitch and Katlama agree, for once... and consider it for 2/7. That's really cool. Katlama says with booster, Leibo says without...
As long as I have to choose between MONO-DTG 4/7 and DTG/ATV 2/7, for me it's all clear: DTG/ATV 2/7... And there's nothing to stop you from starting MONO-DTG --> MONO-DTG 4/7 --> DTG/ATV 2/7, with Katlama for example.
OMNIBUS-3D
You can also consider, and this is the easiest way, to advance to 3/7 with your Triumeq®, it is eligible for the OMNIBUS-3D trial and so are you, since you are successful in 4/7. OMNIBUS-2D is not yet finalized, but Triumeq® is definitely in! Triumeq® 2/7
My personal experience includes 4/7, 1/7, 1/15 (modified Leibo method), Mono-DTG, in 4/7, in 1/7 (failure), Bi DTG with 3TC or with ATV. The only thing where we have the satisfaction of moving forward is 4/7, 3/7, 2/7, 1/7, etc
| Strategy | Toxicity Unit per week | commentary |
| Bullshit IRR (7/7) | 21 | if you have shares in Labs... |
| Bi: DTG + 3TC, 7/7 | 14 | validated (Lamidol) |
| Any classical IRT 4/7 | 12 | soon outdated? |
| Bi: DTG + 3TC, 4/7 | 8 | Omnibus-Bicycle, not started |
| Quadri-Leibo (2/7) | 8 | rigorously demonstrated, but Videx® unavailable |
| Mono-DTG 7/7 | 7 | caution (Achilles heel and compliance) |
| Mono-DTG 4/7 | 4 | caution (Achilles heel and compliance) |
| Quadri-Leibo (1/7) | 4 | rigorously proven, but Videx® unavailable |
| Charles-Edouard formula! | 3 | new 1/7 (1/15) under exploration |
Who to consult
In this case, it's not the doctor that matters, it's the close CVs: if the doctor gives you the prescription, it's free, otherwise it's 70 Euros per CV: not the end of the world... This is the big advantage of Triumeq ® 3/7 or 2/7! You don't have to worry about it! The caution is to make sure that the CVs are close together
That's how I keep the same doctor: he is not at the forefront, that's for sure! In the worst case, no doctor would be suitable for me... Leibo is out of the picture, since he has announced to leave the case(considering his age, it's understandable and inevitable). Katlama, hurry up, retirement is coming soon, but once the plan is made, it's made.
I have published a list of caring doctors, you choose...
Obviously, the alter egos of de Truchis, like Landman or PM Girard, will not be an interesting second opinion for you, it's kif-kif, besides, they are bound by the ANRS trials...
For an enlightened strategic definition Katlama(or maybe Valérie MARTINEZ) at the Salpé, and you also start to take issue with Jean Derouineau, who had the good and nice idea to ask to be part of the list and who does a little bit of everything, in town medicine.
News from Omnibus
It's finally happening! The consultation period around the protocol is coming to an end and it is finalized: we still have to convince some clinicians, and this is well on the way. Well... It's going on... As for the financing, I'm making progress too... Well... Needless to say that the winds are against me, but well... I've just succeeded in an absolutely smoking coup, in a related field, and, moreover, I've been told that the financing is on the right track. And it's a nice funding! I'm going to have the approval letter framed, I'm so happy!
In the news
