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
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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.
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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 …
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Well, we have seen non-compliance in ART regimens driving drug escape mutants in HIV+ individuals
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Yes, especially when used outpatient.
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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.
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Out of curiosity, what happens if someone declines to take pill on zoom? What about someone pantomiming taking a pill? How is it enforced?
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Good to see you coming around
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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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