AIDS TREATMENT UPDATE, November 1995
Keith Alcorn

An AIDS Treatment Update survey carried out last month amongst doctors at ten major centres in the UK indicates there will be strong demand for saquinavir. Demand looks set to outstrip that for the 3TC expanded access programme, which has already attracted more than 400 patients in the UK.

"I think that saquinavir is likely to be attractive to patients who have no other options left because it is the first of a new class of drugs which look promising, and because it shows none of the toxicities associated with other anti-HIV drugs" said Dr Ian Williams of London's Mortimer Market HIV clinic. "Patients who are AZT-experienced and wondering what to do after Delta may well want to try saquinavir."

Although Roche is not putting a ceiling on the number of people who can be supplied with saquinavir in the UK, the drug is known to be in short supply - fewer than 2,000 people in the USA have received the drug through an expanded access lottery. Such a lottery scheme was rejected by the company as inappropriate for Europe.

"We hope that it won't be necessary to ration access to saquinavir, so we're asking doctors to be prudent in their enrollment of patients" said Stuart Knight of Roche. "This is an expanded access scheme for people who have no further treatment options."

LIMITED ACCESS TO INDINAVIR

Other protease inhibitors currently in development will not be so easy to access. This is because they are very difficult to manufacture, say drug companies, and supplies are extremely tight.

AIDS Treatment Update has learnt that Merck, manufacturer of indinavir, has allocated enough drug for an expanded access scheme for only thirty people in the UK. Only three HIV clinics - the Chelsea and Westminster Hospital and the Mortimer Market Centre in London, and Edinburgh Royal Infirmary - will be asked to put forward patients for the scheme, and some doctors are angry that patients at their centres will not have the chance to receive indinavir.

Indinavir will be made available to people with CD4 counts below 50, and use in combination with anti-retrovirals such as AZT, ddI and ddC will be permitted. This programme will start in December, but AIDS Treatment Update understands that no further drug will be made available owing to the difficulty in manufacturing indinavir.

RITONAVIR NOT AVAILABLE

Ritonavir, the protease inhibitor manufactured by Abbott, is another drug in very short supply. Earlier this year the company told doctors at two London hospitals that a small amount of the drug would be made available for expanded access, but the company has still made no firm commitment to establish such a scheme.

A spokesman for Abbott told AIDS Treatment Update that the company was still looking at how to implement an expanded access programme in the light of very limited supplies of the drug.

"If there are more expanded access programmes the options for patients are greater, and the pressure is less on individual programmes because there will be more drug to go round" said Dr Ian Williams.

GETTING SAQUINAVIR

Doctors who wish to obtain saquinavir through the expanded access programme should contact Dr Gordon Cox at Roche on 01707 366000.

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