An ongoing dialogue on HIV/AIDS, infectious diseases,
April 14th, 2010
Maraviroc Rarely Used for Treatment-Naive Patients
Over in Journal of Infectious Diseases, the MERIT study was recently published (with Chuck Hicks’ Journal Watch summary here), demonstrating that maraviroc is non-inferior to efavirenz — provided that the enhanced-sensitivity tropism test is used to select appropriate candidates.
(The MERIT study began in 2004-5. Don’t think I’ll ever forget that, since the investigator meeting overlapped with this memorable series. Notable event pictured.)
Despite these favorable results from the trial — and the FDA approval of the drug for treatment-naive patients — I agree with Chuck that mariviroc will get little use in this population, if only because the “preferred” alternatives (efavirenz, atazanavir/r, darunavir/r, raltegravir) are so incredibly good.
Our reader poll (right side of page) confirms how rarely the drug is prescribed as initial therapy. I suspect that some of the respondents who said they have given the drug to these patients did so within a clinical trial, which would make the response even lower.
Will maraviroc — or another CCR5 antagonist — ever have widespread use in HIV treatment?
Call me an optimist, but I envision that these drugs will be part of an aggressive eradication strategy, somehow based on the remarkable case of “cure” following bone marrow transplantation from a CCR5-negative donor.
Hey, I can dream can’t I? Red Sox fans certainly did in 2004.
Paul E. Sax, MD
Associate Editor
NEJM Clinician
Biography | Disclosures & Summaries
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