(ATN) New Flu Medicine Approved, But Untested with HIV

(ATN) New Flu Medicine Approved, But Untested with HIV

AIDS TREATMENT NEWS Issue #187, November 19, 1993
Dave Gilden and John S. James

With a particularly severe flu season predicted, Forest Pharmaceuticals of St. Louis has received FDA approval to market a new drug aimed specifically at the influenza A virus. The new drug, rimantadine (brand name: Flumadine), supplements an older anti-influenza medication, amantadine. Both drugs are believed to be about equally effective in combating influenza A -- shortening the number of sick days by half. But use of amantadine has been restricted by its considerable central nervous system side effects (for example, insomnia, nervousness, depression). Rimantadine, according to the FDA-approved package insert, cuts the rate of adverse reactions by 50 percent. However, its price is triple that of amantadine.

The use of flu vaccine is officially recommended at this time for people with HIV. But an anti-influenza drug (if it is well tolerated) could still be important because:

* It is not known how well the vaccine works for people with serious immune deficiencies;

* The vaccine must be used well in advance of exposure to the virus to provide protection. But the drugs are still partly effective even if used shortly after symptoms have begun;

* Rimantadine can be used to prevent the flu when somebody's personal contacts come down with the disease;

* If the influenza strain mutates, it may escape control by the vaccine but still be susceptible to the drug.

The anti-flu medications cannot replace the flu vaccine. One reason is that rimantadine and amantadine do not protect against influenza B, as a vaccine can. Also, partially resistant strains of influenza have developed in up to one- third of the people treated with either of the drugs. The implications of this observation for widespread use of rimantadine or amantadine are not known.

Comment

Rimantadine has not been tested in persons with HIV. Persons with AIDS or symptomatic HIV disease often have more serious side effects from some drugs than other patients do. Because of the lack of information, it is difficult to compare risks and benefits of rimantadine for those patients.

If any clinical research organization could move very rapidly, it could make an important contribution by running a small safety test of this drug on volunteers with symptomatic HIV infection, even before the flu season arrives. Then, if a severe flu epidemic does develop, the medical community will have more guidance on this use of this potential tool.

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