BioCryst Pharmaceuticals,Inc. (BCRX)

[tenman325]

BCRX why we need PPERAMIVIR

The cytokine storm produced by the deep lung infection of pandemic h1n1 renders oseltamivir ineffective. IL-6 (interleukin 6) suppresses conversion in the liver into the active (oseltamivir carbolylate) form of oseltamivir.

http://en.wikipedia.org/wiki/Interleukin...

The sicker you get from the flu the less oseltamivir carboxylate is available to fight it off. This is also likely to favor selection of resistant variants of the virus. Doctors are probably underdosing critically ill patients with oseltamivir. This variability in dosing with tamiflu makes peramivir a superior product in the critically ill.

http://molpharm.aspetjournals.org/cgi/co...

In fact tamiflu is not even labeled, i.e. FDA approved, for use in critical illness.

"Treatment of Influenza
TAMIFLU is indicated for the treatment of uncomplicated acute illness due to influenza infection in patients 1 year and older who have been symptomatic for no more than 2 days."

http://www.rxlist.com/script/main/art.as...

Acute illness: A disease with an abrupt onset and usually a short course.

The problem is that in some patients, especially those with asthma who have baseline elevated levels of IL-6, may die inside of the 48 hour treatment window when treated with oseltamivir. If you read the labeling it is clear that tamiflu is not intended to be used in the critically ill.

Peramivir in contrast does not require carboxylation to be bioactive. It is not a prodrug. We are left without an FDA-approved drug that is indicated for complicated cases i.e. the critically ill.

Roche does not have the manufacturing capability for producing a liquid form of relenza, and has to do safety trials once they can make it in commercial quantities.

I believe there is face-saving going on. The government experts loaded up on tamiflu and now that they need it are finding it doesn't fit the bill. They must have known this and chose to buy a boatload anyway, probably because GSK was passing out campaign contributions. By the time somebody gets sick enough to really need antivirals it's too late for tamiflu and they are too sick to take relenza. If they pass them out to be taken at the first sign of sniffles, we'll get drug resistance and then we have nothing. So they sit on their hands and hope nobody important gets sick and dies. Where is poetic justice when you need it?