|
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
|
|
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
|
|
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
|
|
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.
|
|
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.
|
|
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.
|
|
7
|
- 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
|
|
8
|
|
|
9
|
|
|
10
|
- Please discuss and recommend future study designs /data acquisition for
the heavily pretreated population.
|