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Viramune vs. Sustiva
Nov 18, 1999

There has been some disagreement in my on-line discussion group as to which one of these two drugs is more effective. I was under the impressionn they were equally effective. Comments? Studies to back up your assestments? Thanks

Response from Dr. Pavia

I hope no one on your discussion group is a drug company representative, since there is a lot of marketing hype on this debate. Usually, when there is a debate like this it is because there really is no answer, like the Viracept, Crixivan argument of a few years back.

The simple answer is that until there is a head to head comparison, we cannot really answer the question. The studies that have been done of the two drugs are not comparable, so you cannot directly compare. My feeling is that both are highly effective, relatively easy to take, have relatively low "barriers" to resistance making it important that they be paired with other active drugs, and each has unique characteristics. There could be subtle differences in efficacy, although I doubt it.

In general the studies on Sustiva have been more clear cut studies, in part because they were done more recently. Dupont's 006 study compared Sustiva, AZT, 3TC to Crixivan, AZT, 3TC in a large number of patients and showed they were at least equivalent, with Sustiva showing an edge, probably related to more people actually sticking with it and taking all there doses. The independent ATLANTIC study compared Virammune, d4T, ddI with Crixivan, d4T, ddI, and showed they were equivalent, as well. There were more patients with very high viral loads in the Sustiva studies, so there was some question about efficacy in high viral loads for Virammune, but a new study presented in Lisbon a few weeks ago, the 1090 study, shows impressive activity for Virammune in patients with very high viral loads

Soo...The choice usually comes down to other factors - drug interactions, comparing side effects, cost, prejudice. There is a head to head study starting soon called 2NN, that will compare them head to head and then we'll know.

ATP



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