Sequential PI therapy
Posted: Aug 8, 2006
QUESTION:
Considering all else equal (drug interactions, Hep C status etc...), in an experienced patient with multiple PI mutations who is currently susceptible to both Tipranavir/r and darunavir/r, is it better to use one PI over the other, in hopes to sequence therapy? Likely will combine either these PIs with enfuvirtide.
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RESPONSE FROM: 
Thanks for your post.
I think that sequential use of tipranavir and darunavir remains an area of clinical and commercial speculation. There are some data that would suggest that tipranavir susceptibility might be preserved following failure of darunavir. To me, the key issue in the selection of either of these newer PIs is the likelihood that the medication will have sufficient potency to suppress virus and will be well tolerated.
So, looking at the susceptibility of the two for your patient- I'd want to know not just the genotypic prediction of response is, but also the predicted phenotypic susceptibility. The drug with the largest margin of susceptibility over the FC cutoff would likely be the drug that I'd select. Given tipranavir's need for 400 mg daily of ritonavir and the recent revelations of intracranial hemmorrage; if all else were equal, I'd probably be inclined to use darunavir.
I hope this is helpful. Let us know how your patient does. BY
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