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The making of the one pill—Developing single tablet regimens for HIV and for HCV 一粒药的制造——开发针对艾滋病毒和丙型肝炎病毒的单片剂方案
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-04-01 DOI: 10.1177/13596535211067606
Taiyin Yang, R. Oliyai, K. Kent
A concept of “all or nothing” inspired the innovation of a one-pill-once-daily HIV treatment. Atripla® was the one pill that combined efavirenz, emtricitabine, and tenofovir disoproxil fumarate to become the first daily single tablet regimen that forever simplified HIV treatment to enhance patient compliance and thus, sustained viral suppression. The making of Atripla incorporated dry granulation and bilayer compression technologies to achieve stability and bioequivalence in an optimal pill size. In 2011, there lacked a standard of care for chronic hepatitis C infections that was safe, simple, short, free of interferon and ribavirin, and with high cure rates. A fixed-dose combination of ledipasvir and sofosbuvir was developed and approved in 2014 to be the first complete daily single tablet regimen for CHC genotype 1 infection. A spray-drying process for particle morphology engineering in a polymer matrix was used for improving bioavailability.
“要么全有,要么全无”的理念激发了每天一次的一粒HIV治疗的创新。Atripla是一种结合了依非韦伦、恩曲他滨和富马酸替诺福韦二氧吡酯的药片,成为第一个永远简化HIV治疗的每日单片方案,提高患者的依从性,从而持续抑制病毒。Atripla的制作结合了干燥造粒和双层压缩技术,以达到最佳药丸尺寸的稳定性和生物等效性。2011年,慢性丙型肝炎感染缺乏一种安全、简单、短期、不含干扰素和利巴韦林、治愈率高的标准治疗方法。ledipasvir和sofosbuvir的固定剂量组合于2014年被开发并批准,成为首个用于治疗基因型1型CHC感染的完整每日单片方案。为了提高生物利用度,采用喷雾干燥技术在聚合物基质中进行颗粒形态工程。
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引用次数: 0
Providing access to high-quality, low-cost medicines across low and middle-income countries (LMICs), working with governments and generic manufacturers around the globe - A business case 在中低收入国家(LMIC)提供高质量、低成本的药品,与全球政府和仿制药制造商合作-商业案例
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-04-01 DOI: 10.1177/13596535211068617
G. Alton, Clifford Samuel, A. Reddi
Background Gilead Sciences, under Dr. John Martin’s leadership, created its Global Access Program to deliver high-quality, affordable medicines to treat and ultimately eliminate some of the world’s most challenging-to-treat, pervasive, life-limiting diseases not as philanthropy but based on a self-sustaining business model—a highly novel concept in the pharmaceutical realm. John was determined to bring together all key stakeholders from public health officials to doctors and patients around the globe to understand barriers and opportunities in HIV, viral hepatitis, and visceral leishmaniasis (VL) and in so doing, pushed the Gilead team to devise novel strategies to address healthcare disparities in resource-challenged geographies. Purpose This case study provides an overview of the evolution and impact of the Gilead Access to Medicines Program in providing treatments for HIV in low- and lower middle-income countries.
背景:在约翰·马丁博士的领导下,吉利德科学公司创建了其全球获取计划,以提供高质量、负担得起的药物来治疗并最终消除世界上一些最难治疗、普遍存在、限制生命的疾病,这不是慈善事业,而是基于自我维持的商业模式——这是制药领域的一个非常新颖的概念。John决心将从公共卫生官员到全球医生和患者的所有关键利益相关者聚集在一起,了解艾滋病毒、病毒性肝炎和内脏利什曼病(VL)的障碍和机会,并以此推动吉利德团队制定新的战略,以解决资源短缺地区的医疗保健差距。目的本案例研究概述了吉利德药品获取计划在中低收入国家提供艾滋病毒治疗方面的演变和影响。
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引用次数: 0
The role of tenofovir disoproxil fumarate for preventing vertical transmission of hepatitis B 富马酸替诺福韦预防乙型肝炎垂直传播的作用
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-04-01 DOI: 10.1177/13596535221076640
C. Pan
Background Since immunoprophylaxis failure can occur if maternal serum hepatitis B virus (HBV) DNA levels are >200,000 IU/ml, tenofovir disoproxil fumarate (TDF) therapy has been investigated for preventing mother to child transmission (PMTCT). Methods A literature search for maternal TDF therapy for PMTCT between 1/1/2015 and 7/1/21 on PUBMED, EMBASE, Cochrane, CNKI, and Wanfang databases was performed. Data from RCTs in English or Chinese were extracted and reviewed. The outcomes of interest included the efficacy and safety of TDF versus placebo for PMTCT. Results Among 11 RCTs identified from the databases, the risk-of-bias was low. All studies demonstrated that maternal TDF therapy initiated from the second or third trimester for highly viremic chronic hepatitis B mothers is highly effective and safe in the PMTCT of HBV, except one RCT performed in Thailand which showed no therapeutic advantage on TDF treatment versus placebo for PMTCT (0% vs 3% transmission). Recent emerging data suggest that maternal TDF therapy initiated at the 2nd or early 3rd trimester in mothers with HBV DNA >200,000 IU/ml achieved viremic control before delivery. In the 4-year long follow-up study for maternal TDF therapy, there were no impacts on infants’ physical growth, psychological or mental development, and bone mineral density after fetal exposure to TDF. In the light of updated efficacy and safety data from RCTs, an algorithm was proposed. The approaches in resource-limit areas were discussed. Conclusions TDF is safe for both mothers and infants as the preferred therapy for PMTCT in highly viremic mothers. TDF should be initiated at the second or early third trimester in the combination of the appropriate infants’ immunoprophylaxis.
背景:由于如果母体血清乙型肝炎病毒(HBV)DNA水平大于200000 IU/ml,则可能发生免疫预防失败,因此研究了富马酸替诺福韦二酯(TDF)治疗预防母婴传播(PMTCT)的方法。方法在PUBMED、EMBASE、Cochrane、CNKI和万方数据库中检索2015年1月1日至21年7月1日期间母体TDF治疗PMTCT的文献。从英文或中文的随机对照试验中提取数据并进行审查。感兴趣的结果包括TDF与安慰剂治疗PMTCT的疗效和安全性。结果在数据库中确定的11项随机对照试验中,偏倚的风险较低。所有研究都表明,从妊娠中期或晚期开始对高病毒血症的慢性乙型肝炎母亲进行的母体TDF治疗对HBV的PMTCT是非常有效和安全的,但在泰国进行的一项随机对照试验显示,与安慰剂相比,TDF治疗在PMTCT方面没有任何治疗优势(0%对3%的传播)。最近出现的数据表明,在HBV DNA>200000 IU/ml的母亲中,在妊娠中期或晚期早期开始的母体TDF治疗在分娩前实现了病毒血症控制。在为期4年的母体TDF治疗随访研究中,胎儿接触TDF后对婴儿的身体生长、心理或精神发育以及骨密度没有影响。根据随机对照试验的最新疗效和安全性数据,提出了一种算法。讨论了资源限制领域的做法。结论TDF作为治疗高病毒血症母亲PMTCT的首选疗法,对母亲和婴儿都是安全的。TDF应在妊娠中期或晚期早期开始,结合适当的婴儿免疫预防。
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引用次数: 2
Discovery and development of oseltamivir at Gilead Sciences 吉利德科学公司奥司他韦的发现和开发
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-04-01 DOI: 10.1177/13596535211067598
U. Schmitz, S. Swaminathan
John Martin’s untimely death in March 2021 was a huge loss for us personally, Gilead Sciences, the company he built over 30 years and the scientific community concerned with antiviral therapies. We wish to honor John’s legacy by retelling the discovery and history of Tamiflu and his contributions to it. Without his vision, persistence, and keen eye for opportunities, Tamiflu would not exist and Gilead’s path would not have been the same. His strategic thinking around the first oral flu drug is still quite relevant today, when we are still in the SARS-CoV-2 pandemic. John explained it simply in an interview with the Science History Institute in May 2020: “…most of my colleagues, we travel with Tamiflu when we go internationally, because it works for treatment and prevention, and hopefully, there will be a solution like that, eventually, for the Covid virus in addition to vaccines. Most people will get a flu vaccine every year, but there is still disease, we need a pill for treatment and prevention.”
约翰·马丁于2021年3月英年早逝,这对我们个人、吉利德科学公司、他30多年来建立的公司以及关注抗病毒疗法的科学界来说都是一个巨大的损失。我们希望通过复述达菲的发现和历史以及他对达菲的贡献来纪念约翰的遗产。如果没有他的远见、毅力和对机会的敏锐眼光,达菲就不会存在,吉利德的道路也不会一样。在我们仍处于严重急性呼吸系统综合征冠状病毒2型大流行的今天,他对第一种口服流感药物的战略思考仍然非常重要。约翰在2020年5月接受科学历史研究所采访时简单地解释了这一点:“……我的大多数同事,当我们去国际旅行时,我们都会带着达菲旅行,因为它对治疗和预防有效,希望最终除了疫苗之外,新冠肺炎病毒也会有这样的解决方案。大多数人每年都会接种流感疫苗,但仍有疾病,我们需要一片治疗和预防药物。”
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引用次数: 0
Changes in blood lipids in patients with chronic hepatitis B after 48 weeks of tenofovir alafenamide treatment: A prospective real-world clinical study 替诺福韦阿拉那胺治疗48周后慢性乙型肝炎患者血脂的变化:一项前瞻性现实世界临床研究
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-04-01 DOI: 10.1177/13596535221082399
Yeqiong Zhang, Zhipeng Li, Q. Luo, Wenxiong Xu, Lu Wang, Shu Zhu, L. Peng, Chang Xie
Background Tenofovir alafenamide (TAF) is a new anti-hepatitis B virus nucleotide analogue that can cause dyslipidaemia in AIDS patients, but the effect of TAF on blood lipids in patients with chronic hepatitis B (CHB) is unknown. This study aimed to evaluate the effect of TAF on blood lipid levels in patients with CHB. Methods One hundred and twenty-one CHB patients were recruited as TAF group, including 69 treatment-naïve patients and 52 patients with nucleoside/nucleotide analogue experience before TAF treatment. All patients were followed up regularly for 48 weeks. Total cholesterol (TC), low-density lipoprotein cholesterol (LDL-C) and triglyceride (TG) levels and the incidence of dyslipidaemia before and after TAF treatment were compared. Results After 48 weeks of TAF treatment, the levels of TC, TGs and LDL-C in TAF group were significantly higher than those in control group. In TAF group, the TC and TG levels were significantly higher than that at baseline. Baseline TC and TGs levels had a significant effect on the incidence of abnormal TC and TG levels after 48 weeks treatment. The LDL-C decreased slightly but not significantly. The proportion of patients with TC abnormalities increased from 20.7% at baseline to 26.3% at week 48, LDL-C abnormalities decreased from 50.4% to 42.5% and TG abnormalities increased from 14.2% to 22.5%. There were no significant differences compared with control group, as well as compared with baseline. Conclusions Tenofovir alafenamide treatment mainly affects the TC and TG level in patients with CHB but has little effect on LDL-C.
替诺福韦阿拉芬胺(TAF)是一种新的抗乙型肝炎病毒核苷酸类似物,可引起艾滋病患者血脂异常,但TAF对慢性乙型肝炎(CHB)患者血脂的影响尚不清楚。本研究旨在评估TAF对慢性乙型肝炎患者血脂水平的影响。方法121例CHB患者作为TAF组,其中treatment-naïve患者69例,TAF治疗前有核苷/核苷酸类似物治疗经验的患者52例。所有患者定期随访48周。比较TAF治疗前后总胆固醇(TC)、低密度脂蛋白胆固醇(LDL-C)、甘油三酯(TG)水平及血脂异常发生率。结果TAF治疗48周后,TAF组TC、tg、LDL-C水平均显著高于对照组。TAF组TC、TG水平明显高于基线。治疗48周后,基线TC和TG水平对TC和TG异常发生率有显著影响。LDL-C略有下降,但不明显。TC异常的患者比例从基线时的20.7%上升到第48周时的26.3%,LDL-C异常从50.4%下降到42.5%,TG异常从14.2%上升到22.5%。与对照组及基线比较均无显著差异。结论替诺福韦alafenamide治疗主要影响CHB患者TC和TG水平,对LDL-C影响不大。
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引用次数: 1
The transformation of HIV therapy: One pill once a day HIV治疗的转变:每天一粒
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-04-01 DOI: 10.1177/13596535211062396
Madhuchanda Choudhary, J. Mellors
A co-formulated, one pill once a day antiretroviral regimen (single-tablet regimen), containing efavirenz, emtricitabine, and tenofovir disoproxyl fumarate (Atripla), revolutionized the antiretroviral therapy landscape. Single-tablet regimens provide not only dosing convenience but help optimize adherence and persistence with antiretroviral therapy to achieve durably suppressed viremia with both individual and societal benefits. Given the many excellent options available now, single-tablet regimens are the preferred choice for initiating antiretroviral therapy in almost all patients with rare exceptions for drug interactions and pregnancy, and for simplification of more complex antiretroviral therapy to a single-tablet regimen. In this special commemorative article, we celebrate this astounding advancement in antiretroviral therapy, championed by John C. Martin while CEO of Gilead Sciences, and its transformative impact on HIV care nationally and globally.
一种含有依非韦伦、恩曲他滨和富马酸替诺福韦二丙酯(Atripla)的联合配方、每天一片的抗逆转录病毒疗法(单片疗法)彻底改变了抗逆转录病毒治疗的格局。单片方案不仅给药方便,而且有助于优化抗逆转录病毒疗法的依从性和持久性,以实现持久抑制的病毒血症,并带来个人和社会效益。鉴于目前有许多优秀的选择,单片方案是几乎所有患者开始抗逆转录病毒治疗的首选方案,药物相互作用和妊娠的罕见例外,以及将更复杂的抗逆转录病毒疗法简化为单片方案的首选方案。在这篇特别的纪念文章中,我们庆祝由吉利德科学公司首席执行官约翰·C·马丁倡导的抗逆转录病毒疗法的这一惊人进步,以及它对全国和全球艾滋病毒护理的变革性影响。
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引用次数: 2
The curing regimens of HCV: A SWOT analysis 丙型肝炎病毒治疗方案的SWOT分析
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-04-01 DOI: 10.1177/13596535211072672
M. Cornberg, M. Manns
The development of direct-acting antivirals (DAA) has revolutionized the treatment of chronic hepatitis C, enabling cure of hepatitis C virus (HCV) infection in more than 95% of cases. There are essentially no contraindications, so almost any patient can now be successfully treated. The result is the prevention or amelioration of cirrhosis, hepatocellular carcinoma (HCC), and extrahepatic manifestations. Consequently, the 2020 Nobel Prize in Medicine and Physiology was awarded for the discovery of HCV. Due to the high efficacy of therapy, even global HCV elimination is conceivable even without a vaccine. Here, we would like to venture a SWOT analysis of current HCV therapies aimed at HCV elimination.
直接作用抗病毒药物(DAA)的开发彻底改变了慢性丙型肝炎的治疗,使95%以上的病例能够治愈丙型肝炎病毒(HCV)感染。基本上没有禁忌症,所以现在几乎任何患者都可以成功治疗。其结果是预防或改善肝硬化、肝细胞癌(HCC)和肝外表现。因此,2020年诺贝尔医学和生理学奖因丙型肝炎病毒的发现而获得。由于治疗的高效性,即使没有疫苗,也可以想象全球消除丙型肝炎病毒。在这里,我们想对目前旨在消除丙型肝炎病毒的丙型肝炎病毒疗法进行SWOT分析。
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引用次数: 3
Tenofovir alafenamide fumarate 富马酸替诺福韦
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-02-01 DOI: 10.1177/13596535211067600
William A Lee, A. Cheng
Tenofovir alafenamide fumarate is a lipophilic prodrug of tenofovir which is preferentially metabolized in lymphatic tissue resulting in high concentrations of tenofovir (TFV) and its active diphosphate metabolite inside the cells that replicate HIV. Due to its selectivity for these tissues, lower total doses of TAF can be administered relative to tenofovir disoproxil fumarate (TDF) which results in improved bone and renal biomarkers. Tenofovir alafenamide fumarate has become the “backbone” of multiple combination products for the treatment of HIV, combined with emtricitabine for PreP and as a monotherapy for the treatment or HBV.
富马酸替诺福韦阿拉胺是替诺福韦的亲脂性前药,在淋巴组织中优先代谢,导致在复制HIV的细胞内产生高浓度的替诺福韦(TFV)及其活性二磷酸代谢物。由于其对这些组织的选择性,相对于富马酸替诺福韦二氧吡酯(TDF), TAF的总剂量可以降低,从而改善骨骼和肾脏生物标志物。富马酸替诺福韦阿拉那胺已成为治疗HIV的多种联合产品的“骨干”,与恩曲他滨联合用于PreP,并作为治疗HBV的单一疗法。
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引用次数: 4
Commentary: Development of Therapeutics for Congenital Cytomegalovirus Infection 评论:先天性巨细胞病毒感染治疗方法的进展
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-02-01 DOI: 10.1177/13596535211060968
R. Whitley
In the mid 1980’s, I flew from Birmingham, Alabama to San Francisco, rented a car, and drove to Palo Alto so that I could meet with John Martin at Syntex. John, along with Julian Verheyden, synthesized ganciclovir, which had significant in vitro activity against cytomegalovirus (CMV) in vitro. This drug provided my colleagues and me an opportunity to evaluate it as a therapeutic agent for congenital CMV infection, knowing full well that it was mutagenic, teratogenic, and carcinogenic. John in his wisdom convinced the management of Syntex to provide ganciclovir for this disease, allowing me to study this drug in symptomatic congenitally infected children through the NIAID Collaborative Antiviral Study Group (CASG). Certainly, no other person or company would advocate for the use of such a medication in children, regardless of disease severity, because of its toxicity profile. Since these early days, ganciclovir, and subsequently its prodrug valganciclovir, have become the standard of care for the treatment of congenital cytomegalovirus infection. The following commentary defines the need and progress in the development of therapy
80年代中期,我从阿拉巴马州的伯明翰飞到旧金山,租了一辆车,然后开车到帕洛阿尔托,在Syntex公司与约翰·马丁会面。John和Julian Verheyden在体外合成了更昔洛韦(ganciclovir),该药物对巨细胞病毒(CMV)具有显著的体外抗活性。这种药物为我和我的同事提供了一个机会来评估它作为先天性巨细胞病毒感染的治疗药物,我们完全知道它是诱变的、致畸的和致癌的。约翰以他的智慧说服了Syntex的管理层为这种疾病提供更昔洛韦,使我能够通过NIAID协同抗病毒研究小组(CASG)研究这种药物在有症状的先天性感染儿童中的作用。当然,没有其他个人或公司会提倡在儿童中使用这种药物,无论疾病严重程度如何,因为它的毒性。从早期开始,更昔洛韦及其前药缬更昔洛韦就成为治疗先天性巨细胞病毒感染的标准药物。下面的评论定义了治疗发展的需要和进展
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引用次数: 1
Preemptive acyclovir to prevent herpes simplex virus bronchopneumonitis in mechanically ventilated patients with herpes simplex virus oropharyngeal reactivation: An ancillary study of the preemptive treatment for herpesviridae trial 单纯疱疹病毒口咽再激活机械通气患者预防性阿昔洛韦预防单纯疱疹病毒支气管肺炎:一项针对单纯疱疹病毒试验的预防性治疗的辅助研究
IF 1.2 4区 医学 Q3 Medicine Pub Date : 2022-02-01 DOI: 10.1177/13596535211072673
Antoine Troger, S. Burrel, M. Pineton de Chambrun, M. Schmidt, N. Brechot, Olivier Bomme, G. Hékimian, A. Combes, D. Boutolleau, C. Luyt
Background To evaluate the impact of preemptive acyclovir treatment on herpes simplex virus (HSV) bronchopneumonitis in mechanically ventilated patients with HSV oropharyngeal reactivation. Methods Ancillary study of the Preemptive Treatment for Herpesviridae (PTH) clinical trial. Patients included in that trial from one centre (Pitié-Salpêtrière Hospital) and in whom at least one bronchoalveolar lavage (BAL) was performed for ventilator-associated pneumonia suspicion were included in the present study. Rate of HSV bronchopneumonitis, defined as clinical symptoms suggesting of pneumonia and presence of HSV in BAL fluid ≥105 copies of HSV/106 cells, were compared in patients who received either acyclovir or placebo. Results Eighty-three patients were included; 40 having received preemptive acyclovir and 43 having received a placebo, without differences between groups at admission or at randomization. The number of patients who developed HSV bronchopneumonitis was lower among acyclovir-treated patients than among placebo-treated patients (40% vs. 72%, respectively, p = .003). Results were similar when restricted to patients without HSV detected in the lower respiratory tract at randomization (31% vs. 61%, respectively, p = .03). Conclusions Preemptive acyclovir treatment in mechanically ventilated patients with HSV oropharyngeal reactivation reduces HSV bronchopneumonitis rate.
背景:在单纯疱疹病毒口咽再激活的机械通气患者中,评估先发制人的阿昔洛韦治疗对单纯疱疹病毒(HSV)支气管肺炎的影响。方法辅助研究疱疹病毒科(PTH)预防性治疗的临床试验。本研究纳入了来自一个中心(Pitié-Salpêtrière医院)的试验患者,这些患者至少接受了一次支气管肺泡灌洗(BAL)治疗,怀疑是呼吸机相关性肺炎。在接受阿昔洛韦或安慰剂治疗的患者中,比较HSV支气管肺炎的发生率,即表明肺炎的临床症状和BAL液中存在HSV≥105拷贝HSV/106细胞。结果83例患者入选;40人接受了先发制人的阿昔洛韦治疗,43人接受了安慰剂治疗,在入院或随机分组时各组之间没有差异。在阿昔洛韦治疗的患者中,发生HSV支气管肺炎的患者数量低于安慰剂治疗的患者(分别为40%和72%,p=0.003)。当随机分组时仅限于下呼吸道未检测到HSV的患者时,结果相似(分别为31%和61%,p=0.03)HSV口咽再激活的通气患者可降低HSV支气管肺炎的发生率。
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引用次数: 0
期刊
Antiviral Therapy
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