Stavudine extended release (once-daily, Bristol-Myers Squibb) for the treatment of HIV/AIDS

Abstract

Introduction: Stavudine extended release (d4T XR) was a formulation which tried to solve the two main problems associated with the use of stavudine immediate release (d4T IR). These were twice daily dosing schema at a time when most formulations were long-life allowing once daily dosing; and that the use of d4T IR was associated with long-term toxicity through mitochondrial toxicity clinically expressed as peripheral neuropathy, pancreatitis and above all, lipodystrophy. The link between stavudine exposure and lipodystrophy had a great negative impact on its use in clinical practice.

Areas covered: The authors cover the most relevant papers related to the efficacy and safety of d4T XR-based antiretroviral therapy.

Expert opinion: The development of d4T XR has only been partially successful with regard to its objectives. Improved pharmacokinetic properties allow its once daily dosing, and although it exhibits less mitochondrial toxicity it is still hampered by its development in a significant proportion of patients. This has caused its use to be almost residual in industrialised countries. As of now, d4T XR has not been made available in developing countries, despite the extended use of the immediate-release formulation. Currently, if there is no other chance of starting combination antiretroviral therapy, d4T XR could play a role in the treatment of HIV infection.

Keywords::

• AIDS
• Bristol-Myers Squibb
• efficacy
• HIV-1 infection
• lipodystrophy
• once daily
• peripheral neuropathy
• pharmacodynamics
• pharmacokinetics
• stavudine extended release
• stavudine immediate release

Declaration of interest

This work has been partially funded by Fondo de Investigaciones Sanitarias (FIS PI08/00256 and PI10/2635), Fundación para la Investigación y Prevención del SIDA en España (FIPSE 36610, 36572/06), Ministerio de Sanidad, Politica Social e Igualdad (EC11-293), Programa de Suport als Grups de Recerca AGAUR (2009 SGR 1061) and Red de Investigación en SIDA (RIS RD06/006/0022, RD06/0006/1004). P Domingo and F Vidal are supported by grants from the Programa de Intensificación de Investigadores, Instituto de Salud Carlos III (INT12/383 and INT11/240).

Notes

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