Replies to post #88617 on Biotech Values

[DewDiligence]

Re: The New battle Lines in HIV

Correct me if I'm wrong, but boosted PIs have an extremely high resistance barrier, definitely higher than any NNRTI or II.

I do not understand what you mean—boosting in this context is altering the pharmacokinetics of a PI to enable qD rather than BID dosing. How does this enhance the barrier to resistance?

More importantly, I do not agree that the "third agent paradigm" is here to stay indefinitely.

What is your definition of indefinitely? I expect the last enforceable US patent on Truvada to run out in Jan 2018 (#msg-34894135), and I think it’s unlikely the SoC in early lines of HIV treatment will move away from a Truvada backbone before then.

Truvada may be the cleanest nuke but there are cleaner classes now, so I wouldn't be surprised to see nuke-sparing regimens come to dominate first line at some point because of improved tolerability.

I could be wrong but I don’t see this happening before 2018. Regards, Dew

[DewDiligence]

…I do not agree that the "third agent paradigm" is here to stay indefinitely. Truvada may be the cleanest nuke but there are cleaner classes now, so I wouldn't be surprised to see nuke-sparing regimens come to dominate first line at some point because of improved tolerability.

According to GILD’s 4Q09 CC yesterday, Truvada is used by 81% of Isentress patients and 91% of Prezista patients in the first-line setting. If anything, the Truvada “paradigm” appears to be strengthening rather than weakening as new HIV agents are added to the armamentarium. Regards, Dew