Dolutegravir Approval Signals a Beginning and the End of Something Very Special

August 12, 2013

Paul E. Sax, M.D.

Paul E. Sax, M.D., is director of the HIV Program and Division of Infectious Diseases at Brigham and Women's Hospital in Boston.

As anticipated, the FDA approved dolutegravir today for HIV treatment, the third integrase inhibitor now available.

This was about as surprising as the arrival of Royal Baby Prince George. We knew dolutegravir was coming soon, just not exactly when or what it would be named.

Here's a short list of the data we have thus far on this drug from various comparative clinical trials:

Plus, results from another phase III study -- vs boosted darunavir -- should be available soon.

About the only downsides of this drug are first, that there is currently no single-pill initial treatment (said to be in the works), and second, that the brand name is still another mysteriously unpronounceable choice selected by marketing gurus undoubtedly paid much more than we are.

("Tivicay." Let's see, is it Tivi-SAY, or Tivi-KAY? Or TI-visay or TI-vikay? Or maybe it's a long I on the first syllable, as in "tie ..." Gosh, who knows. Better call the people who know how to say Intelence and Stribild and Fulyzaq.)

Pronunciation aside, this is the beginning of this extraordinarily promising antiviral agent.

But it's the end of a remarkable stretch of HIV drug development, one that started in 2006 with darunavir, then marched through with maraviroc, raltegravir, etravirine, rilpivirine, and elvitegravir. The availability of these drugs, now with dolutegravir, means that pretty much anyone who takes their medications will achieve virologic suppression.

Because after the tweak of tenofovir -- TAF -- what's next?

Paul Sax is Clinical Director of Infectious Diseases at Brigham and Women's Hospital. His blog HIV and ID Observations is part of Journal Watch, where he is Editor-in-Chief of Journal Watch AIDS Clinical Care.

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This article was provided by NEJM Journal Watch. NEJM Journal Watch is a publication of the Massachusetts Medical Society.


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