Idenix Pharmaceuticals (IDIX)

[gofishmarko]

>>> this begs the question - for pts with high viral loads (and perhaps e ag positivity), should combination therapy be started earlier? <<<

Anna Lok is heading a symposium at EASL on combo therapy in HBV. In areas where cost is not so much of a concern , I think combos of direct antivirals will become SOC for all tx.-naive patients where ifn is contraindicated , and a suitable option even for those that could use ifn. As in HIV , I think it is becoming clear that very long-term suppression without generation of resistance is best achieved by use of effective combos first , rather than sequential single-agent use or add-on therapy. In the case of lam-resistant patients , add-on of adefovir or switching to an all new regimen may be a closer call.

I'm guessing that there are a lot of lam patients out there who are either resistant now or will be before too long and for them adefovir may have the advantage , especially in add-on usage , over other agents because of cross-resistance profiles , but I don't know how cost of that combo compares to other treatment options. I agree that lam monotherapy in naive patients will only occur where cost is paramount , and the cost of lam will probably decline in an attempt to maintain some market share. Where cost is a major concern I'd guess that usage of resistance genotype testing is minimal and docs rely on published cross-resistance info to make tx.decisions , which again would probably favor adefovir in the lam-resistant cohort.