HIV and ID Observations

The psoriasis drug Raptiva (efalizumab) has been linked to progressive multifocal leukoencephalopathy:

On Oct. 16, 2008, FDA updated the FDA-approved labeling for Raptiva to warn of the risk of life-threatening infections, including PML. On Feb. 19, 2009, the FDA issued a Public Health Advisory informing patients and prescribers of the risk of PML in patients taking Raptiva, after receiving reports of four patients with PML, three of whom died.

When I was a fellow, Bob Rubin emphatically taught us that there’s no such thing as a free lunch when it comes to immunosuppression.  I think of this each time one of these newer agents is linked with a severe infectious complication.

But while I was getting some background information on the drug, I came upon this ugly site — and there are others like it already. They can join sites like this one and this one for nataluzimab (Tysabri), the multiple sclerosis drug also linked to PML.  These legal firms pounce on drug withdrawals like hungry dogs waiting for table scraps to fall on the floor.

Yes, welcome to America and all, but could anyone actually think that these powerful drugs for difficult-to-treat autoimmune diseases would be risk free? The fact that nataluzimab is available again for MS — now with a comprehensive monitoring program — serves as proof that sometimes the disease is worse than the side effects.

And reminds us ID docs that decisions about whether to use these drugs are tough ones indeed.