I believe the reason for Dolutegravir with kids is the high genetic barrier to resistance. With kids needing to take drugs decades, limited the resistance developed is top priority. So giving one with a high barrier to resistance is first in line. A few years ago it was the big chance, the holy grail, as the most likely for monotherapy. Read this and smile, there only one still standing, leronlimab .
http://i-base.info/blog/2015/10/why-dolutegra...-research/
Why dolutegravir might get us closer to ending AIDS:
So my question to BP as leronlimab monotherapy gets p3 pivotal trial ?
http://i-base.info/blog/2015/10/why-dolutegra...-research/
Why dolutegravir might get us closer to ending AIDS:
Quote:Is this the first time using fewer drugs has been studied?
No, the interest in reducing the drugs to treat HIV has been around for a long time. Almost as soon at the first studies in 1996/7 showed that combination therapy worked, there were studies looking at whether people could start treatment with one combination and then cut back later to a reduced maintenance combination later. But these studies – including the ACTG 343 in the US, the Trilege study in France and the Adam study in the Netherlands failed very quickly. Viral load quickly rebounded when 3 drugs were reduced to one or two drugs and most people developed drug resistance. [8]
About a decade later, monotherapy was studied again using boosted protease inhibitors, especially lopinavir/ritonavir (Kaletra) and then more recently the PIVOT study used darunavir/ritonavir monotherapy. Although these later results were much better that the first maintenance studies, dropping the use of other drugs – especially NRTIs (nukes) – generally led to higher rates of viral rebound and certainly were never as good as combinations with three active drugs. [9, 10]
Why are the new results so surprising and exciting?
The results with dolutegravir are surprising because they would not have been possible with any other single drug.
For the last 30 years, the vulnerability of HIV drugs to develop resistance has been a serious limitation of every HIV drug. This was why early studies using single and dual therapy only produced very short-term benefits. HIV is a rapidly evolving virus and unless viral load is reduced on ART to less than 50 copies/mL and kept this low, the development of drug resistance is nearly always inevitable. With some drugs and combinations, drug resistance takes time to accumulate slowly. But with others, resistance can occur within a few weeks. These results with dolutegravir could change everything, and some prominent researchers, including Professor Mark Weinberg, who has reported on this aspect of dolutegravir over several years, thinking this might play an additional role in strategies for a cure. [11]
So my question to BP as leronlimab monotherapy gets p3 pivotal trial ?
