As First-Line Combination Therapy VIRACEPT(R) Most Frequently Selected Protease Inhibitor. In a new survey assessing physicians’ experience with HIV resistance, 71% of physicians who initiate therapy with a protease inhibitor (PI) chose a single PI over a dual PI, reserving use of dual PIs for future therapy. Among those choosing a single PI, 63% selected Viracept (nelfinavir), 18% Crixivan(R) (indinavir), 4% Norvir(R) (ritonavir), 4% Fortovase/Invirase(R) (saquinavir), 1% Kaletra(TM) (lopinavir/ritonavir) and 1% Agenerase(R) (amprenavir).
The survey, conducted by Roper Starch Worldwide, Inc., comprised 300 physicians who had written at least twenty-two prescriptions for HIV medications in the past month and treat an average of 120 patients. Half of the physicians surveyed were board certified in infectious diseases and half were primary care physicians.
Physicians reported that 33% of their patients experienced resistance after initiation of antiretroviral therapy. Resistance is considered one of the leading causes of treatment failure among people living with HIV. Resistance in HIV therapy is defined as the virus’ failure to respond following treatment and its subsequent active replication, or reproduction, of itself. Drug resistance may develop for a variety of reasons based on individual responses to specific drug therapies.
When asked about preserving future treatment options, Viracept was the most frequently mentioned PI, cited by 21% of the physicians as allowing their patients more salvage therapy options should resistance develop. This response was three times greater than mention of any other protease inhibitor by the physicians participating in the survey.
“When used first line, Viracept may afford patients and physicians subsequent treatment options based on its unique resistance profile,” said Frank Palella, M.D., Assistant Professor, Division of Infectious Diseases, Northwestern University Medical School. “Proper sequencing of initial and salvage therapy is particularly important for patients and physicians with limited options.”
Currently Prescribed Regimens
On average, physicians reported that 35% of their patients, the largest segment of their practice, received a single PI combination, compared to 18% who received a single non-nucleoside reverse transcriptase inhibitor (NNRTI)-based combination and 12% who received a triple nucleoside analogue (NRTI) combination.
Among the physicians who choose single PI combinations as first-line therapy, 30% cited drug tolerability as the reason for selecting a particular single PI; 21% chose a drug based on its resistance profile; and 26% selected a drug for its efficacy. Among physicians who initiated therapy with a single NNRTI, 35% based their choice on efficacy; 29% selected for adherence; and 26% for tolerability. Only 2% of those surveyed indicated that they chose a particular NNRTI for its resistance profile.
Late Stage Therapy Options
When asked about therapeutic options most likely to be prescribed for patients who initiated single PI therapy and subsequently developed resistance, 31% of the physicians responded that they prescribe dual PIs while 38% prefer dual PIs plus NNRTI. Among patients who initiated single NNRTI therapy and later developed resistance, 33% of the physicians said that they chose a single PI for subsequent therapy, while 51% prefer a dual PI regimen.
The telephone-administered survey was conducted by Roper Starch Worldwide during January 2001. The survey sample was obtained from National Data Corporation Health Information Services, which tracks prescriptions from terminals at 34,000 pharmacies nationwide. The data collected at the terminal is cross-referenced to the American Medical Association database to provide descriptive information on every sample physician including name, telephone number and specialty. The survey was sponsored by Agouron Pharmaceuticals, Inc.
Agouron Pharmaceuticals, Inc., a Pfizer Company (NYSE:PFE), is committed to the discovery, development, and marketing of innovative therapeutic products engineered to inactivate proteins that play key roles in cancer, AIDS, and other serious diseases. Agouron employs more than 1400 people of whom approximately 850 are engaged in research and development.
Pfizer Inc discovers, develops, manufactures and markets leading prescription medicines, for humans and animals, and many of the world's best known consumer products. Pfizer had global revenues of $29.6 billion in 2000. Pfizer plans to make a research and development investment of about $5 billion in 2001.
Agenerase(R) is a registered trademark of Glaxo-Wellcome Inc. Crixivan(R) is a registered trademark of Merck & Co., Inc. Fortovase(R) is a registered trademark of Roche Laboratories, Inc. Kaletra(TM) is a registered trademark of Abbott Laboratories. Norvir(R) is a registered trademark of Abbott Laboratories. Viracept(R) is a registered trademark of Agouron Pharmaceuticals, Inc.
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