[e-farmacos] Estavudina y toxicidad. Verdad o estrategia de mercado? (cont.)

["Satue, Eduardo" <e.satue.000@recol.es>]

Apreciado Juan,

La ultima actualizacion de la lista de medicamentos esenciales de la OMS,
que como sabes trata de equilibrar el acceso, la seguridad y la eficacia de
los medicamentos comenta algo al respecto. Concretamente dice, al valorar la
adicion de la dosis fija combinada (FDC) de lamivudina / stavudina / nevirapina:

"As noted, d4T is the NRTI most associated with lactic acidosis, lipoatrophy and peripheral neuropathy and therefore countries should be planning to move away from treatment regimens that include it.

However, d4T options are currently the most accessible, so appropriate
monitoring needs to be carried out for short? and long?term toxicities.
As noted by the Committee, this combination is one of several proposed in
the WHO treatment guidelines, and is a preferred combination for first\line
treatment, and can be used in most sub?populations of HIV patients, including pregnant women and children.

Several products of adequate quality exist, containing appropriate doses of
the components and there are clinical studies using the components of the FDC at the same doses and several observational studies using this FDC. There is substantial experience of use of this product in resource\poor settings but there is significant toxicity with this combination that
may eventually lead to a decline in its use. It is widely accessible. The
Committee also noted the advice from the HIV/AIDS Department that the 40 mg stavudine containing FDC would no longer be recommended, due to excess toxicity of the higher dose.

The Committee therefore recommended that the FDC containing stavudine 30 mg,
lamivudine and nevirapine should be added to the Model List, but not the
product containing stavudine 40 mg."

Asi, la OMS contempla la fuerte toxicidad de la stavudina y desaconseja el
uso de la dosis de 40 mg, tanto en las FDC como en monoterapia (auqnue todavia no la ha retirado formalmente) pero avala el uso de las FDC con
stavudina de 30 mg y tambien en monoterapia de 30 mg.

Eduardo Satue