EFFECTIVE TREATMENT FOR SMALLPOX - Cidofovir - BUT NOT FOR YOU

Office of Evaluation, Government Performance and Results Act - http://www1.od.nih.gov/gpra/ ^ | 2000 - 2001 (various release dates for studies) | Martinez, Bray, Huggins, ETAL

[dandelion]

This is the only credible reference I have seen in regards to a possible treatment for smallpox. Cidofovir has some undesireable side effects, most notably kidney damage; but considering the horrors of smallpox, I would certainly take the risk were I infected.

Bottom line: Cidofovir is available, and appears to be an effective (if not absolute) treatment for smallpox. BUT ACCORDING TO THE NYC DEPT OF HEALTH website it will NOT BE OFFERED due to the fact it is in vitro - experimental. If threatened by smallpox, we should be offered the option to access it for treatment. We need to start asking questions NOW if we want to be able to access this possibly life-saving treatment...

[dandelion]

Well, well, well - pretty please, would you lovely fellas give this a bump in the night? I think it might be bump worthy, especially considering that we are being told there is no treatment for smallpox...

[arielb]

yes there is. smallpox vaccine works even after you get infected

[piasa]

We shouldn't be concerned about TREATING it when we can PREVENT it altogether with vaccination. Since no one has it, vaccination is the issue. And we have the ability to prepare vaccines and get those started... first with people who have never been vaccinated and with the very old, as they will be the most vulnerable.

[dandelion]

Considering that there are limited amounts of vaccine available (between 2 million and 15 million, depending on to whom you listen) and considering the fact that the vaccine is old and may have to be diluted to stretch it, I would certainly prefer that I have access to the drugs as well...

[dandelion]

The vaccines that you and I received had a shelf-life of 10-12 years according to medical experts - and once again, thanks to clinton, we have NO plant currently producing vaccine. The planned DILUTIONS of the 15 million vaccines available will not be ready until NEXT SUMMER. If a massive outbreak of smallpox occurs, many may be exposed who will have no access to vaccines. We will need to have the option of accessing this available drug which is currently in production.

[Movemout]

Interesting medication but it needs a lot more testing.

[dandelion]

NOTE: Common name of Cidofovir - "Vistide". A search of the term on this Formulary page reveals another clue as to why the government may not be offering this drug up front - it is expensive. Gilead Sciences offers programs to make the drug available to HIV patients... what, I wonder, are the chances they would make it more available to victims of a massive outbreak of smallpox??

[dandelion]

If my children have smallpox, I think that they are worthy of the same consideration as an AIDS patient...

[gueroloco]

YES!

[Centurion2000]

...

[piasa]

The virus can mutate all it wants but it is still susceptible to the cowpox vaccine.

[dandelion]

That is, IF you can get the vaccine... this drug is available, and they are saying it appears to be effective against smallpox. The vaccine will not be available until AFTER SUMMER 2003 - and unless you are one of the luck 15-40 million who are chosen to receive it, you will NOT get a vaccine. Cidofovir is already available, it's already FDA approved, and it's already been proclaimed by the government as probably effective against smallpox. It's dangerous, but so is the smallpox vaccine. Cidofovir's available, the vaccine is not. The government has already approved it and tested it - in event of smallpox infection, we should be able to have the option to use cidofovir if we choose.

[Jim Noble]

I have used a fair amount of cidofovir to treat CMV.

It is very difficult to use-it is IV (intravenous) only, and causes major side effects, including kidney failure severe enough to require discontinuation, in over 50% of those treated.

The IV infusion itself is difficult and prolonged.

I am interested in the reference to ribavirin, which is used to treat Hepatitis C and is now available in large quaantities both here and overseas.

[dandelion]

Emedicine has a listing of test results and dosages, (use control+find for the word "vistide", the brand name for cidofovir)...

[slhill]

Hey, cidofovir looks promising for sure. However, it may not work. The FDA has approved its use for the treatment of CMV retinitis, NOT SMALLPOX. So the FDA believes it is relatively safe, under certain clinical conditions, and relatively effective, under certain clinical conditions, for the treatment of CMV retinitis. It will be VERY VERY DIFFICULT to work out if it's effective against smallpox, because (thankfully) no-one has the disease -- so there's no population on which to test it. Animal models are suggestive but far from conclusive -- plenty of drugs don't get through phase III trials (the big efficacy trials that do double-blinded tests on a big population). So a hint of caution may be in order.

[dandelion]

Definitely caution - this would NOT be something one would want to do as a "precautionary measure". However, according to the Emedicine link " Cidofovir (Vistide)- A nucleoside analog DNA polymerase inhibitor; if administered within 48 h of exposure, may attenuate or avoid infection; adefovir, cidofovir, and ribavirin are under investigation for smallpox".

Since we have nothing better, and those who have been studying it have come up with suggested doses, it begs the question - will we be given the option to try cidofovir, considering that it's risks are - by all accounts - significantly lower than that of smallpox?

[dandelion]

Does that rate of kidney failure reflect those patients taking Probenecid? I understand that the rate of kidney failure is quite high in those patients who are not taking Probenecid, I'm curious to the renal failure rate of those who take Cidofovir with Probenecid. Probably no one would prescribe it WITHOUT Probenecid, but I'm not sure if their are contraindications for HIV patients to take Probenecid...