{"id":881,"date":"2010-04-14T11:19:07","date_gmt":"2010-04-14T15:19:07","guid":{"rendered":"http:\/\/blogs.nejm.org\/?p=881"},"modified":"2015-06-04T15:25:26","modified_gmt":"2015-06-04T19:25:26","slug":"maraviroc-rarely-used-for-treatment-naive-patients","status":"publish","type":"post","link":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/maraviroc-rarely-used-for-treatment-naive-patients\/2010\/04\/14\/","title":{"rendered":"Maraviroc Rarely Used for Treatment-Naive Patients"},"content":{"rendered":"<p><img loading=\"lazy\" decoding=\"async\" class=\"alignright size-full wp-image-883\" title=\"dave_roberts_steal\" src=\"http:\/\/blogs.nejm.org\/hiv-id-observations\/wp-content\/uploads\/sites\/2\/2010\/04\/dave_roberts_steal11.jpg\" alt=\"dave_roberts_steal\" width=\"336\" height=\"180\" \/>Over in <em>Journal of Infectious Diseases<\/em>, the MERIT study <a href=\"http:\/\/www.journals.uchicago.edu\/doi\/abs\/10.1086\/650697\" target=\"_blank\">was recently published<\/a> (with Chuck Hicks&#8217; <em>Journal Watch<\/em> summary <a href=\"http:\/\/aids-clinical-care.jwatch.org\/cgi\/content\/full\/2010\/329\/2?q=snotice_ac\" target=\"_blank\">here<\/a>), demonstrating that maraviroc is non-inferior to efavirenz &#8212; provided that the enhanced-sensitivity tropism test is used to select appropriate candidates.<\/p>\n<p>(The MERIT study began in 2004-5. \u00a0Don&#8217;t think I&#8217;ll ever forget that, since the investigator meeting overlapped with <a href=\"http:\/\/www.baseball-reference.com\/postseason\/2004_ALCS.shtml\" target=\"_blank\">this memorable series<\/a>. \u00a0Notable event pictured.)<\/p>\n<p>Despite these favorable results from the trial &#8212; and the FDA approval of the drug for treatment-naive patients &#8212; I agree with Chuck that mariviroc will get little use in this population, if only because the &#8220;preferred&#8221; alternatives (efavirenz, atazanavir\/r, darunavir\/r, raltegravir) are so incredibly good.<\/p>\n<p>Our <a href=\"http:\/\/aids-clinical-care.jwatch.org\/cgi\/content\/full\/2010\/329\/2?q=snotice_ac\" target=\"_blank\">reader poll<\/a> (right side of page) confirms how rarely the drug is prescribed as initial therapy. \u00a0I suspect that some of the respondents who said they <em>have <\/em>given the drug to these patients did so within a clinical trial, which would make the response even lower.<\/p>\n<p>Will maraviroc &#8212; or another CCR5 antagonist &#8212; ever have widespread use in HIV treatment?<\/p>\n<p>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 &#8220;cure&#8221; following <a href=\"http:\/\/content.nejm.org\/cgi\/content\/full\/360\/7\/692\" target=\"_blank\">bone marrow transplantation from a CCR5-negative donor<\/a>.<\/p>\n<p>Hey, I can dream can&#8217;t I? \u00a0Red Sox fans certainly did in 2004.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>Over in Journal of Infectious Diseases, the MERIT study was recently published (with Chuck Hicks&#8217; Journal Watch summary here), demonstrating that maraviroc is non-inferior to efavirenz &#8212; provided that the enhanced-sensitivity tropism test is used to select appropriate candidates. (The MERIT study began in 2004-5. \u00a0Don&#8217;t think I&#8217;ll ever forget that, since the investigator meeting [&hellip;]<\/p>\n","protected":false},"author":6,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[2,4,8],"tags":[77,161,258,423,587],"class_list":["post-881","post","type-post","status-publish","format-standard","hentry","category-antiretroviral-rounds","category-hiv","category-patient-care","tag-antiretroviral-therapy","tag-ccr5-antagonists","tag-cure","tag-hiv","tag-maraviroc"],"post_mailing_queue_ids":[],"_links":{"self":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/881","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/users\/6"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/comments?post=881"}],"version-history":[{"count":0,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/posts\/881\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/media?parent=881"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/categories?post=881"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.nejm.org\/hiv-id-observations\/index.php\/wp-json\/wp\/v2\/tags?post=881"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}