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Question 1
  • Do the data demonstrate that tipranavir/ritonavir (TPV/r)
  • is safe and effective for the multi-drug resistant HIV-1 infected
  • population?


  • If no, what additional data are needed to provide evidence of safety and efficacy?


  • If yes, please address the appropriate population for TPV/r use considering the following:
    • limited inclusion criteria of the RESIST trials
    • drug-drug interactions
    • resistance information and patterns associated with optimal use
    • safety considerations
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Question 2
  • Given the data on transaminase elevations,
  • please provide your recommendations for:
  • TPV/r use in patients with underlying liver disease
  • Monitoring and management of hepatotoxicity during clinical use
  • Future studies
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Question 3
  • The limited amount of data in females with HIV infection in the TPV program shows an increased incidence of rash in females.  Please provide your recommendations for:
    • Investigation of this safety signal in future studies with TPV
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Question 4
  • Current information indicates the net effect of TPV/r on substrates of CYP1A2, CYP2C9, CYP2C19 and CYP2D6 is not known, and there are competing effects of TPV/r on CYP3A (inhibition) and P-glycoprotein (induction).  Please comment on additional post-marketing drug interaction studies.
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Question 5
  • Given the high inter-patient variability in TPV exposures following fixed doses and exposure (blood levels)-virologic response relationships, could a biomarker such as Cmin/IC50 be used for the individualization of TPV/r therapy?  Please discuss the studies that would supplement the data presented today.
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Question 6
  • Please provide your recommendations regarding the display of TPV/r resistance data/analyses in the TPV package insert that would be useful to clinicians.


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Examples
  • Baseline Outcome Analyses
    • Baseline Number of PI Mutations
    • Type of PI Mutation
    • Baseline Phenotype
    • TPV score
    • Key mutations
  • Endpoints
    • Primary endpoint (proportion of responders)
    • Change from Baseline (e.g. median, average)
  • +/-T20 use


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Response by Baseline Number
of PI Mutations


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Response by Baseline PI Mutations
Median Change from Baseline - Overall


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Question 7
  • Please discuss and recommend future study designs /data acquisition for the heavily pretreated population.