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Dereklowe's profile
Derek Lowe
Derek Lowe
Derek Lowe
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@Dereklowe

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Derek LoweVerified account

@Dereklowe

Drug discovery chemist and blogger Note: all opinions, choices of topic, etc. are strictly my own – I don’t in any way speak for my employer (or anyone else).

Massachusetts
blogs.sciencemag.org/pipeline
Joined November 2008

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    Derek Lowe‏Verified account @Dereklowe 6 Dec 2021

    Derek Lowe Retweeted zeynep tufekci

    This is an unfortunately good point: will patient noncompliance on Molnupiravir treatment regimes bring on the viral-mutant problems that many have worried about? I haven't been as concerned about that, but this would be the way it could happen. . .https://twitter.com/zeynep/status/1467890223145172996 …

    Derek Lowe added,

    zeynep tufekciVerified account @zeynep
    One question I have is what happen with patience non-compliance? The pill is supposed to be taken over five days, every 12 hours at home (I think 40 pills total). There's going to be a lot of incomplete regimens in this scenario. How does this affect this risk?
    Show this thread
    9:17 AM - 6 Dec 2021
    • 18 Retweets
    • 152 Likes
    • Ebitdamannen Kate Summers laura W W. Dow Rieder Rednecklefty CZEdwards (she/her/they/them) 💉💉💉 Alex Hughes-Smith Asha Fix Ann Mc
    7 replies 18 retweets 152 likes
      1. Oxana‏ @MyGardenLady 6 Dec 2021
        Replying to @Dereklowe

        Still better than the goddamn Incivek that's taken 3 times a day exactly 8 hours apart with 20 grams of fat every time (while many patients suffer from nausea) for 3 months

        0 replies 0 retweets 0 likes
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      2. zeynep tufekci‏Verified account @zeynep 6 Dec 2021
        Replying to @Dereklowe

        I am certain we will get substantive levels of patient noncompliance, skipped doses, erratic timing, early stopping etc. and also re-targeting (left-over/hoarded pills being shared). I'd like some clarity on how that affects this tail risk—not to the patient but to society.

        1 reply 2 retweets 22 likes
      3. Prasad Jallepalli, MD, PhD‏ @jallepap 6 Dec 2021
        Replying to @zeynep @Dereklowe

        We have dealt with this issue before with TB. Standard therapy involves taking multiple antibiotics for 6 months. Gaps are a main driver of resistance. For this reason, directly observed therapy (DOT) is used to monitor compliance, supplemented w/PH law. https://www.health.ny.gov/publications/3705.pdf …

        1 reply 0 retweets 2 likes
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      1. Roberto Pereira‏ @rcr_pereira 6 Dec 2021
        Replying to @Dereklowe

        Well, we have seen non-compliance in ART regimens driving drug escape mutants in HIV+ individuals 🤔

        0 replies 0 retweets 0 likes
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      1. Anand C. Patel, MD MS‏ @anandcpatelmdms 6 Dec 2021
        Replying to @Dereklowe

        Yes, especially when used outpatient.

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      2. Prasad Jallepalli, MD, PhD‏ @jallepap 6 Dec 2021
        Replying to @Dereklowe @NavinPokala

        For TB, we've long used directly observed therapy (DOT) - now aided by Zoom - to ensure long-term compliance with medication, precisely to avoid the emergence of drug resistant TB. I don't see any reason we couldn't use DOT here.

        1 reply 0 retweets 1 like
      3. Navin Pokala‏ @NavinPokala 6 Dec 2021
        Replying to @jallepap @Dereklowe

        Out of curiosity, what happens if someone declines to take pill on zoom? What about someone pantomiming taking a pill? How is it enforced?

        1 reply 0 retweets 0 likes
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      1. John Klopfer‏ @johnklopfer 6 Dec 2021
        Replying to @Dereklowe

        Good to see you coming around

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      1. Charlie Stross‏Verified account @cstross 8 Dec 2021
        Replying to @Dereklowe

        A Q here: if course is successful, how long before symptoms abate? If symptomatic relief happens before course is finished, some patients may not complete (extrapolating from antibiotics). But if symptoms taper off over > 5 days, there's a better chance of achieving compliance.

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