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Medical Forum / Diseases and Disorders / Hepatitis / January 2006

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Alinia

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mc - 13 Jan 2006 01:52 GMT
This drug is on the market now for use in intestinal infections and now I
read that they have some studies that show effectiveness in HCV. A new study
is in the works. anyone know anything about it?
mc
greyhackles - 13 Jan 2006 02:40 GMT
>This drug is on the market now for use in intestinal infections and now I
>read that they have some studies that show effectiveness in HCV. A new study
>is in the works. anyone know anything about it?
>mc

http://www.natap.org/2006/HCV/011006_02.htm

Could be very interesting, particularly because Alinia is already marketed in
most if not all parts of the world, so the regulatory path could be very
short.

Cheers

/greyhackles (very pleased to see all this pharma attention to HCV!)
Doug - 13 Jan 2006 02:44 GMT
>>This drug is on the market now for use in intestinal infections and now I
>>read that they have some studies that show effectiveness in HCV. A new
[quoted text clipped - 12 lines]
>
> /greyhackles (very pleased to see all this pharma attention to HCV!)

Romark Seeks FDA OK
Romark Laboratories of Tampa said Tuesday it filed an application with the
Food and Drug Administration seeking permission to market its drug Alinia
for treatment of hepatitis C, a chronic liver disease. Alinia is already
approved for use against two common diarrheal diseases. The company wants to
compare Alinia's performance in U.S. trials, following promising results in
Egypt.

             Here's something I found               Doug
Doug - 13 Jan 2006 02:48 GMT
>>>This drug is on the market now for use in intestinal infections and now I
>>>read that they have some studies that show effectiveness in HCV. A new
[quoted text clipped - 20 lines]
> to compare Alinia's performance in U.S. trials, following promising
> results in Egypt.

            Here's something I found               Doug

I heard they 're using it solo as a monotherapy, or at least trying to.  How
long will it take to get FDA ok?   Grey, Thomas, anybody know...?

Doug
greyhackles - 13 Jan 2006 03:25 GMT
>>>>This drug is on the market now for use in intestinal infections and now I
>>>>read that they have some studies that show effectiveness in HCV. A new
[quoted text clipped - 27 lines]
>
>Doug

That's an interesting question in this case. If a doctor is convinced an
already-approved-drug would be helpful where no alternatives have worked, I
believe s(he) can prescribe same for "off-label" use, even without the
regulatory agency having approved the same drug to be marketed for that
specific purpose.

Ie, if you could find and convince a doc that this was your only shot and it
would do more good than harm, you might be able to legally use it now.

I haven't spend much time googling this Alinia so I don't know what it's
safety profile looks like, but assuming there weren't any grave issues using
it to this point, perhaps this could be a player within a year or so.

Cheers

/greyhackles
Michael Cody - 13 Jan 2006 03:33 GMT
>>>>>This drug is on the market now for use in intestinal infections and now I
>>>>>read that they have some studies that show effectiveness in HCV. A new
[quoted text clipped - 44 lines]
>
> /greyhackles

Makes you think that when you thought a new tx for Hep C wasn't coming
round any time soon, it may come round anyway. I like it and it's about
time Hep C is beginning to get some real attention. I reckon some rich
folks got it ...

Cody

Use the Reply to Sender feature of your news reader program to email me.
Utiliza Responder al Remitente para mandarme un mail.
Whatsup Doc - 14 Jan 2006 05:07 GMT
hcv hits rich people also, Cody.
elmoemerson@webtv.net - 14 Jan 2006 13:40 GMT

Re: Alinia  

Group: alt.support.hepatitis-c Date: Sat, Jan 14, 2006, 12:07am (CST+1)
From: coinsinwell1111@webtv.net (Whatsup Doc)
hcv hits rich people also, Cody.
////////////
That's sooo profound of you, Randy.  To what do you attribute your
knowledge and intelligence?
elmo  

http://community.webtv.net/elmoemerson/DocElmosHepFile

http://community.webtv.net/elmoemerson/TheFamilyAlbum
Waterspider - 14 Jan 2006 18:43 GMT
Re: Alinia

Group: alt.support.hepatitis-c Date: Sat, Jan 14, 2006, 12:07am (CST+1)
From: coinsinwell1111@webtv.net (Whatsup Doc)
hcv hits rich people also, Cody.
////////////
That's sooo profound of you, Randy.  To what do you attribute your
knowledge and intelligence?

Aw, take it easy on the kid... he is only 12.
Isn't he?
elmoemerson@webtv.net - 14 Jan 2006 19:29 GMT

Re: Alinia  

Group: alt.support.hepatitis-c Date: Sat, Jan 14, 2006, 10:43am (CST-2)
From: waterspider@moonlight.net (Waterspider)
<elmoemerson@webtv.net> wrote in message
news:20330-43C8FF5F-708@storefull-3251.bay.webtv.net...
Re: Alinia
Group: alt.support.hepatitis-c Date: Sat, Jan 14, 2006, 12:07am (CST+1)
From: coinsinwell1111@webtv.net (Whatsup Doc)
hcv hits rich people also, Cody.
////////////
That's sooo profound of you, Randy. To what do you attribute your
knowledge and intelligence?
Aw, take it easy on the kid... he is only 12.
Isn't he?
/////////////
Uhhh, I guess.
elmo
Watching Soul Train with the sound turned off and Albert Collins and
Johnny Copeland amped to the max.  Damn, them gals sure can shake that
THING!!
ahahahahahaha!!!!!!

http://community.webtv.net/elmoemerson/DocElmosHepFile

http://community.webtv.net/elmoemerson/TheFamilyAlbum
Waterspider - 14 Jan 2006 20:08 GMT
> Re: Alinia
>
[quoted text clipped - 18 lines]
> THING!!
> ahahahahahaha!!!!!!

Did you see Greyhackles' post about Pandora?
Presuming you've got that pc hooked up and highspeed internet, here's the
link from Greyhackles:
http://www.pandora.com/
You'll love it! Right now, I'm listening to One Room Shack, Buddy Guy!
Only problem is you have to be in the USA <g>

Spidey
elmoemerson@webtv.net - 15 Jan 2006 15:17 GMT

Re: Alinia  

Group: alt.support.hepatitis-c Date: Sat, Jan 14, 2006, 12:08pm (CST-2)
From: waterspider@moonlight.net (Waterspider)
<elmoemerson@webtv.net> wrote in message
news:12634-43C95115-126@storefull-3254.bay.webtv.net...
Re: Alinia
Group: alt.support.hepatitis-c Date: Sat, Jan 14, 2006, 10:43am (CST-2)
From: waterspider@moonlight.net (Waterspider)
<elmoemerson@webtv.net> wrote in message
news:20330-43C8FF5F-708@storefull-3251.bay.webtv.net... Re: Alinia
Group: alt.support.hepatitis-c Date: Sat, Jan 14, 2006, 12:07am (CST+1)
From: coinsinwell1111@webtv.net (Whatsup Doc)
hcv hits rich people also, Cody.
////////////
That's sooo profound of you, Randy. To what do you attribute your
knowledge and intelligence?
Aw, take it easy on the kid... he is only 12.
Isn't he?
/////////////
Uhhh, I guess.
elmo
Watching Soul Train with the sound turned off and Albert Collins and
Johnny Copeland amped to the max. Damn, them gals sure can shake that
THING!!
ahahahahahaha!!!!!!
Did you see Greyhackles' post about Pandora? Presuming you've got that
pc hooked up and highspeed internet, here's the link from Greyhackles:
http://www.pandora.com/
You'll love it! Right now, I'm listening to One Room Shack, Buddy Guy!
Only problem is you have to be in the USA <g>
Spidey
////////////
This webtv have WinAmp or Pandora?  ahahahahahaha!  I'm able to listen
to almost 20 seconds of audio if I get it in an mpeg file.  
Hey Spidey.  Check out the CD "Showdown"  with Albert Collins, Johnny
Copeland and Robert Cray.  Did you check out the Tripwire Band website I
sent ya?  Not Tripwire from Maryland, the one that's from the Ozarks.  I
heard em play at a club called Archie's last night and they were their
usual fabulous.  They played 'Little Wing' by Hendrix, Nathan's guitar
solo was unbelievable.  He picked the guitar with his teeth and did the
behind the back thing.  Really entertaining!  
Elmo

http://community.webtv.net/elmoemerson/DocElmosHepFile

http://community.webtv.net/elmoemerson/TheFamilyAlbum
Doug - 13 Jan 2006 03:34 GMT
>>>>>This drug is on the market now for use in intestinal infections and now
>>>>>I
[quoted text clipped - 40 lines]
> regulatory agency having approved the same drug to be marketed for that
> specific purpose.

That's right... I use neurontin for foot pain, even though it's not legally
marketed for that.

> Ie, if you could find and convince a doc that this was your only shot and
> it
[quoted text clipped - 4 lines]
> using
> it to this point, perhaps this could be a player within a year or so.

It looks pretty safe mostly abdominal pain, nausea, diarreaha, etc.

> Cheers
>
> /greyhackles

Thanks, Doug
kjoh - 13 Jan 2006 04:30 GMT
Hi Folks, the info below is from the 2005 Physician's Desk Reference (CD):

ALINIA  (nitazoxanide)  www.romark.com

Metabolism:    Following oral administration in humans, nitazoxanide is
rapidly hydrolyzed to an active metabolite, tizoxanide
(desacetyl-nitazoxanide). Tizoxanide then undergoes conjugation, primarily
by glucuronidation. In vitro metabolism studies have demonstrated that
tizoxanide has no significant inhibitory effect on cytochrome P450
enzymes.

Elimination:    Tizoxanide is excreted in the urine, bile and feces, and
tizoxanide glucuronide is excreted in urine and bile. Approximately
two-thirds of the oral dose of nitazoxanide is excreted in the feces and
one-third in the urine.

Special Populations
Patients with Impaired Hepatic and/or Renal Function: The pharmacokinetics
of nitazoxanide in patients with impaired hepatic and/or renal function has
not been studied.

Geriatric Patients:    The pharmacokinetics of nitazoxanide in geriatric
patients has not been studied.

MICROBIOLOGY
Mechanism of action
The antiprotozoal activity of nitazoxanide is believed to be due to
interference with the pyruvate:ferredoxin oxido-reductase (PFOR)
enzyme-dependent electron transfer reaction which is essential to
anaerobic energy metabolism. Studies have shown that the PFOR enzyme from
Giardia lamblia directly reduces nitazoxanide by transfer of electrons in
the absence of ferredoxin. The DNA-derived PFOR protein sequence of
Cryptosporidium parvum appears to be similar to that of Giardia lamblia .
Interference with the PFOR enzyme-dependent electron transfer reaction may
not be the only pathway by which nitazoxanide exhibits antiprotozoal
activity.

PRECAUTIONS
General:    The pharmacokinetics of nitazoxanide in patients with
compromised renal or hepatic function have not been studied. Therefore,
nitazoxanide must be administered with caution to patients with hepatic
and biliary disease, to patients with renal disease and to patients with
combined renal and hepatic disease.

ADVERSE REACTIONS
Alinia Tablets:    In controlled and uncontrolled clinical studies of
1,628 HIV-uninfected patients age 12 years and older who received various
dosage regimens of Alinia Tablets, the most common adverse events reported
regardless of causality assessment were: abdominal pain (6.7%), diarrhea
(4.3%), headache (3.1%) and nausea (3.1%). In placebo-controlled clinical
trials using the recommended dose, the rates of occurrence of these events
did not differ significantly from those of the placebo. In
placebo-controlled trials of HIV-uninfected patients age 12 years and
older who received Alinia Tablets for the treatment of diarrhea caused by
Giardia lamblia , approximately 1% of patients discontinued therapy
because of an adverse event.

Adverse events occurring in less than 1% of the patients age 12 years and
older participating in clinical trials of Alinia Tablets are listed below:

Body as a Whole:    asthenia, fever, pain, allergic reaction, pelvic pain,
chills, chills and fever, flu syndrome.

Nervous System:    dizziness, somnolence, insomnia, tremor, hypesthesia.

Digestive System:    vomiting, dyspepsia, anorexia, flatulence,
constipation, dry mouth, thirst.

Urogenital System:    discolored urine, dysuria, amenorrhea, metrorrhagia,
kidney pain, edema labia.

Metabolic & Nutrition:    increased SGPT.

Hemic & Lymphatic Systems:    anemia, leukocytosis.

Skin:    rash, pruritus.

Special Senses: eye discoloration, ear ache.

Respiratory System:    epistaxis, lung disease, pharyngitis.

Cardiovascular System:    tachycardia, syncope, hypertension.

Muscular System:    myalgia, leg cramps, spontaneous bone fracture.
Waterspider - 13 Jan 2006 08:29 GMT
(sorry; top-post)

Thanks, Kojoh and Koko.

Hey, Elmo, d'yah see where the stuff was tested on peeps with Beaver Fever?
Ahahahahahaha!

> Hi Folks, the info below is from the 2005 Physician's Desk Reference (CD):
>
[quoted text clipped - 81 lines]
>
> Muscular System:    myalgia, leg cramps, spontaneous bone fracture.
elmoemerson@webtv.net - 13 Jan 2006 13:52 GMT
Beaver peeps?  Sorta like the pussy's version of Tom Thumb, eh?
elmo
"Hello in there!  Anybody home?" <echo echo>
//////////////
(sorry; top-post)
Thanks, Kojoh and Koko.
Hey, Elmo, d'yah see where the stuff was tested on peeps with Beaver
Fever? Ahahahahahaha!
"kjoh" <kjohyayhoo@nospamyahoo.com> wrote in message
news:4fe10341f903b33c4ad02baec0173488@localhost.talkaboutsupport.com...
Hi Folks, the info below is from the 2005 Physician's Desk Reference
(CD):
ALINIA (nitazoxanide) www.romark.com 
Metabolism:   Following oral administration in humans, nitazoxanide is
rapidly hydrolyzed to an active metabolite, tizoxanide
(desacetyl-nitazoxanide). Tizoxanide then undergoes conjugation,
primarily by glucuronidation. In vitro metabolism studies have
demonstrated that tizoxanide has no significant inhibitory effect on
cytochrome P450 enzymes.
Elimination:   Tizoxanide is excreted in the urine, bile and feces,
and
tizoxanide glucuronide is excreted in urine and bile. Approximately
two-thirds of the oral dose of nitazoxanide is excreted in the feces and
one-third in the urine.
Special Populations
Patients with Impaired Hepatic and/or Renal Function: The
pharmacokinetics of nitazoxanide in patients with impaired hepatic
and/or renal function has
not been studied.
Geriatric Patients:   The pharmacokinetics of nitazoxanide in
geriatric patients has not been studied.
MICROBIOLOGY
Mechanism of action
The antiprotozoal activity of nitazoxanide is believed to be due to
interference with the pyruvate:ferredoxin oxido-reductase (PFOR)
enzyme-dependent electron transfer reaction which is essential to
anaerobic energy metabolism. Studies have shown that the PFOR enzyme
from Giardia lamblia directly reduces nitazoxanide by transfer of
electrons in the absence of ferredoxin. The DNA-derived PFOR protein
sequence of Cryptosporidium parvum appears to be similar to that of
Giardia lamblia . Interference with the PFOR enzyme-dependent electron
transfer reaction may not be the only pathway by which nitazoxanide
exhibits antiprotozoal activity.
PRECAUTIONS
General:   The pharmacokinetics of nitazoxanide in patients with
compromised renal or hepatic function have not been studied. Therefore,
nitazoxanide must be administered with caution to patients with hepatic
and biliary disease, to patients with renal disease and to patients with
combined renal and hepatic disease.
ADVERSE REACTIONS
Alinia Tablets:   In controlled and uncontrolled clinical studies of
1,628 HIV-uninfected patients age 12 years and older who received
various dosage regimens of Alinia Tablets, the most common adverse
events reported regardless of causality assessment were: abdominal pain
(6.7%), diarrhea (4.3%), headache (3.1%) and nausea (3.1%). In
placebo-controlled clinical trials using the recommended dose, the rates
of occurrence of these events did not differ significantly from those of
the placebo. In placebo-controlled trials of HIV-uninfected patients age
12 years and older who received Alinia Tablets for the treatment of
diarrhea caused by Giardia lamblia , approximately 1% of patients
discontinued therapy because of an adverse event.
Adverse events occurring in less than 1% of the patients age 12 years
and older participating in clinical trials of Alinia Tablets are listed
below:
Body as a Whole:   asthenia, fever, pain, allergic reaction, pelvic
pain, chills, chills and fever, flu syndrome.
Nervous System:   dizziness, somnolence, insomnia, tremor,
hypesthesia.
Digestive System:   vomiting, dyspepsia, anorexia, flatulence,
constipation, dry mouth, thirst.
Urogenital System:   discolored urine, dysuria, amenorrhea,
metrorrhagia, kidney pain, edema labia.
Metabolic & Nutrition:   increased SGPT.
Hemic & Lymphatic Systems:   anemia, leukocytosis.
Skin:   rash, pruritus.
Special Senses: eye discoloration, ear ache.
Respiratory System:   epistaxis, lung disease, pharyngitis.
Cardiovascular System:   tachycardia, syncope, hypertension.
Muscular System:   myalgia, leg cramps, spontaneous bone fracture.

http://community.webtv.net/elmoemerson/DocElmosHepFile

http://community.webtv.net/elmoemerson/TheFamilyAlbum
Russ - 13 Jan 2006 17:19 GMT
thanks for the info, interesting.

Signature

Russ
http://www.tannersacre.com

> Hi Folks, the info below is from the 2005 Physician's Desk Reference (CD):
>
[quoted text clipped - 81 lines]
>
> Muscular System:    myalgia, leg cramps, spontaneous bone fracture.
Gordo Mondragon - 13 Jan 2006 04:44 GMT
[...]

> That's an interesting question in this case. If a doctor is convinced an
> already-approved-drug would be helpful where no alternatives have worked, I
[quoted text clipped - 8 lines]
> safety profile looks like, but assuming there weren't any grave issues using
> it to this point, perhaps this could be a player within a year or so.

I'd want to know what the resistance profile is like, but if I didn't
have other options then I'd push for it.

G
Thip - 14 Jan 2006 13:29 GMT
"Gordo Mondragon" <ga_mondragon@yahoo.com> wrote in message
news:ga_mondragon-0D17BA.23401412012006@news-> I'd want to know what the
resistance profile is like, but if I didn't
> have other options then I'd push for it.
>
> G

I don't think I'd care if I puked and sat on the pot for a week
straight--I'm out of options and I AM calling BCLD!
Dwight - 14 Jan 2006 22:39 GMT
> "Gordo Mondragon" <ga_mondragon@yahoo.com> wrote in message
> news:ga_mondragon-0D17BA.23401412012006@news-> I'd want to know what the
[quoted text clipped - 6 lines]
> I don't think I'd care if I puked and sat on the pot for a week
> straight--I'm out of options and I AM calling BCLD!

I'm right behind you Thip. Still haven't tried Infergen yet, but if
something comes along that "might" even be better, I'd be willing to
test it.

Dwight
Gordo Mondragon - 15 Jan 2006 03:34 GMT
> "Gordo Mondragon" <ga_mondragon@yahoo.com> wrote in message
> news:ga_mondragon-0D17BA.23401412012006@news-> I'd want to know what the
[quoted text clipped - 5 lines]
> I don't think I'd care if I puked and sat on the pot for a week
> straight--I'm out of options and I AM calling BCLD!

I would.  I would suspect you've got a battle with any insurance company
but the cost of this couldn't be more than a transplant, I don't think.
Thip - 15 Jan 2006 11:10 GMT
>> "Gordo Mondragon" <ga_mondragon@yahoo.com> wrote in message
>> news:ga_mondragon-0D17BA.23401412012006@news-> I'd want to know what the
[quoted text clipped - 8 lines]
> I would.  I would suspect you've got a battle with any insurance company
> but the cost of this couldn't be more than a transplant, I don't think.

Gordo, my insurance covers transplants (I checked) and I should be hearing
from the transplant coordinator in a few days (or so they tell me).  I'd
happily pay for those pills myself if it meant I could avoid it.
Thomas Wagner - 13 Jan 2006 04:54 GMT
>I heard they 're using it solo as a monotherapy, or at least trying to.  How
>long will it take to get FDA ok?   Grey, Thomas, anybody know...?

I really don't know, but since it's already on the market and obviously
hasn't had significant safety problems, it should sail through pretty
quickly. The length of treatment might be the only problem the FDA could
be concerned about - normal diarrhea treatment is probably 2-3 weeks,
not 24. Anyway, 50% of genotype 4 (which is as difficult, if not more
difficult to treat as geno 1) having ETR is exciting news indeed, though
it's not the end of the story yet. We'll have to wait for how many it
will be an SVR as well.

As greyhackles mentioned, off-label use would be a possibility today if
you find a willing doc. Very small chance of any insurance picking up
the tab, though, and it might be a better idea to wait a while until the
initial results have been verified.

Thomas
Signature

To reach me, complete my last name in the address.

Doug - 13 Jan 2006 14:59 GMT
>>I heard they 're using it solo as a monotherapy, or at least trying to.
>>How
[quoted text clipped - 15 lines]
>
> Thomas

Thomas, thanks for the insight. I really appreciate it.  Doug
Gordo Mondragon - 13 Jan 2006 04:40 GMT
> This drug is on the market now for use in intestinal infections and now I
> read that they have some studies that show effectiveness in HCV. A new study
> is in the works. anyone know anything about it?
> mc

I could only find one reference, from the drug company that makes it:

"A phase II, double-blind, placebo-controlled clinical trial of Alinia
as oral monotherapy in patients with chronic hepatitis C was initiated
in early 2005 at the Romark Digestive Disease Research Center in Egypt.
The patients were infected with HCV genotype 4. Approximately 10% of the
patients had previously failed pegylated interferon and ribavirin
combination therapy.
An interim analysis of the first 20 patients enrolled in the study
showed that 50% of patients receiving Alinia administered orally as one
500 mg tablet twice daily with food had undetectable HCV RNA in serum at
the end of 24 weeks of treatment compared to none of the patients in the
placebo group (P=0.03). Importantly, the drug has been well tolerated by
the patients with no significant side effects. The study is continuing
with patients being followed up to evaluate the durability of response
off-treatment."

This is the same dose that's used to treat intestinal parasites and the
drug has been around for a few years and is still being used, so that's
good news (although it's only given for 3 days.)  

It's probably something they noticed, since it wasn't developed as an
antiviral.

They don't say if the response started out at 100% and 50% developed
resistance, or if it just doesn't work for some people from the get-go.

Interesting, thanks for the reference.

G
 
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