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Clinical Utility of Maraviroc

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Abstract

Maraviroc belongs to the family of chemokine (C-C motif) receptor 5 (CCR5) antagonists that prevent the entry of human immunodeficiency virus (HIV) into host CD4+ T cells by blocking the CCR5 co-receptor R5. Maraviroc is currently the only CC5R co-receptor inhibitor that has been approved for clinical use in HIV-1-infected patients carrying the CCR5 tropism who are antiretroviral-na:?ve or have experienced therapeutic failure following traditional antiretroviral therapies. This article is a review of the main characteristics of maraviroc and the latest data regarding its clinical application.

Maraviroc is effective and well tolerated in pre-treated and antiretroviral-naïve patients with HIV-1 infections carrying the CCR5 tropism. Data from the phase III programme of maraviroc, which includes the MOTIVATE 1 and 2 studies and the MERIT study, indicate that maraviroc significantly (p < 0.001) increases CD4+ cell counts compared with placebo in pre-treated patients and to a similar extent as efavirenz in antiretroviral-naïve patients. Even in cases where viral load is not completely suppressed, maraviroc improves immunological response compared with placebo. In addition, promising research suggests that maraviroc has favourable pharmacokinetic and safety profiles in patients with high cardiovascular risk or those co-infected with tuberculosis or hepatitis and could be considered an option for treatment of HIV-infected patients with these co-morbidities.

Resistance to maraviroc is low and mainly related to the presence of chemokine (C-X-C motif) receptor 4 (CXCR4) tropism HIV-1-infections or to mutations in the V3 region of glycoprotein (gp) 120; however, the exact mechanisms by which resistance is acquired and their genotypic and phenotypic pattern have not yet been established. It is recommended that a tropism test should be performed when considering maraviroc as an alternate drug in HIV-1-infected patients. Current tropism assays have increased sensitivity to reliably detect CXCR4 HIV with rapid turn-around and at a low cost. Improved detection together with positive data on the drug’s efficacy and safety profiles should help physicians to identify more accurately the appropriate candidates for commencement of treatment with maraviroc.

In summary, maraviroc improves immunological response and has shown favourable pharmacokinetic and safety profiles in patients with high cardiovascular risk or in those co-infected with tuberculosis or hepatitis. Long-term studies are needed to confirm whether therapeutic expectations resulting from clinical trials with maraviroc translate into a real benefit for HIV-1-infected patients for whom traditional antiretroviral therapies have failed or are not suitable.

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Acknowledgements

The authors thank Nadia Rodríguez of Pfizer España for her help in drafting the article. Additional editorial support for this article was provided by Simone Boniface of inScience Communications, a Wolters Kluwer business. This support was funded by Laboratorios Pfizer España.

All the authors contributed equally to this article. The authors are presented in alphabetical order beginning with the letter ‘P’ (chosen by draw as described by Chambers et al., BMJ 2001; 323: 1460–1).

Federico Pulido has received lecturer and consultant fees from Abbott, Bristol-Myers Squibb, Gilead Sciences, GlaxoSmithKline, Janssen-Cilag, Merck Sharp & Dohme and Pfizer. Félix Gutiérrez has received lecturer and consultant fees from Pfizer. Rainel Sánchez-de la Rosa was an employee of Pfizer when this manuscript was developed. Jorge Parra-Ruiz has received consultant fees from Bristol-Myers Squibb, GlaxoSmithKline, Janssen-Cilag, Roche and Pfizer; he has also received grants from GlaxoSmithKline and Roche. Pere Domingo has received lecturer and consultant fees from Bristol-Myers Squibb, Boehringer Ingelheim, Gilead Sciences, ViiV Healthcare, and Janssen-Cilag; he has also received grants from Janssen-Cilag, Boehringer Ingelheim and Gilead Sciences. The other authors have no conflicts of interest that are directly relevant to the content of this review.

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Authors and Affiliations

  1. Hospital Virgen de las Nieves, Granada, Spain

    Jorge Parra

  2. Hospital General de Alicante, Alicante, Spain

    Joaquín Portilla

  3. Hospital 12 de Octubre, Madrid, Spain

    Federico Pulido

  4. Unidad Médica, Pfizer España, Madrid, Spain

    Rainel Sánchez-de la Rosa

  5. Hospital Son Llàtzer de Palma de Mallorca (IUNICS-INM), Palma de Mallorca, Spain

    Carlos Alonso-Villaverde

  6. Hospital Gregorio Marañón, Madrid, Spain

    Juan Berenguer

  7. Hospital CLINIC, Barcelona, Spain

    José L. Blanco

  8. Hospital Sant Pau, Barcelona, Spain

    Pere Domingo

  9. Hospital Ramón y Cajal, Madrid, Spain

    Fernando Dronda

  10. Hospital Virgen de la Arrixaca, Murcia, Spain

    Carlos Galera

  11. Hospital General Universitario de Elche, Alicante, Spain

    Félix Gutiérrez

  12. Hospital Reina Sofía, Cordoba, Spain

    José M. Kindelán

  13. Hospital del Mar, Barcelona, Spain

    Hernando Knobel

  14. Hospital Virgen del Rocío, Seville, Spain

    Manuel Leal

  15. Hospital La Fe, Valencia, Spain

    Jose López-Aldeguer

  16. Hospital Arquitecto Mancide, Ferrol, Spain

    Ana Mariño

  17. Complejo Universitario de Vigo, Pontevedra, Spain

    Celia Miralles

  18. Hospital Germans Trials i Pujol, Badalona, Spain

    José Moltó

  19. Hospital General del Valencia, Valencia, Spain

    Enrique Ortega

  20. Hospital San Pedro-CIBIR, La Rioja, Spain

    José A. Oteo

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  1. Jorge Parra
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  2. Joaquín Portilla
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  3. Federico Pulido
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  4. Rainel Sánchez-de la Rosa
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  5. Carlos Alonso-Villaverde
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  6. Juan Berenguer
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  7. José L. Blanco
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  8. Pere Domingo
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  10. Carlos Galera
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  18. José Moltó
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  19. Enrique Ortega
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  20. José A. Oteo
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Correspondence to Federico Pulido.

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Parra, J., Portilla, J., Pulido, F. et al. Clinical Utility of Maraviroc. Clin. Drug Investig. 31, 527–542 (2011). https://doi.org/10.2165/11590700-000000000-00000

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