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Rectal Microbicide Development FDA Antiviral Advisory Committee 20 th August, 2003. Ian McGowan M.D., Ph.D. Center for HIV & Digestive Diseases at David Geffen School of Medicine, UCLA. Three Questions. Why develop rectal microbicides?
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Rectal Microbicide Development FDA Antiviral Advisory Committee20th August, 2003 Ian McGowan M.D., Ph.D. Center for HIV & Digestive Diseases at David Geffen School of Medicine, UCLA
Three Questions • Why develop rectal microbicides? • What are the challenges in rectal microbicide development? • What is the current status of rectal microbicide development?
Why Develop Rectal Microbicides? • Anal intercourse (AI) is the primary risk factor for HIV transmission among MSM. • The prevalence of AI among the heterosexual population is underappreciated and represents a significant risk for HIV transmission. • Much AI is unprotected. • The rectal mucosa is highly vulnerable to HIV infection. • Based on the N-9 experience, vaginal products may not be suitable for rectal administration.
What are the Challenges in Rectal Microbicide Development? • Creating awareness that rectal microbicide development is needed • Development strategy not defined • Vaginal products • Rectal products • Combination Rectal & vaginal products • Safety evaluation of candidate rectal microbicides not established
Screening for Phase1 rectal studies Are Phase1 rectal studies needed to support a vaginal microbicide NDA? Design of Phase1 rectal studies Vaginal Microbicide Pipeline
Are Conventional Safety Studies Sufficient for Rectal Microbicides? CCR5 Expression
What is the Current Status of Rectal Microbicide Development? • N-9 has been shown to be unsafe as a rectal microbicide • Carraguard™ did not induce epithelial damage • No Phase 1 microbicide studies are currently planned
Summary • There is an urgent need to develop rectal microbicides for the MSM population • Anal intercourse is an underappreciated risk factor for HIV transmission in heterosexuals • Vaginal microbicides need to be evaluated in the rectal compartment prior to NDA approval. • Rectal microbicides require an appropriate preclinical and clinical development track