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Executive Summary

ONTARIO RETROVIR NEW SCRIPTS ARE DOWN 41% IN WAKE OF CONCORDE study results released in June, according to a poster presented during the First National Conference on Human Retroviruses and Related Infections in Washington D.C. Dec. 14. A review of payments by the Ontario provincial government for Burroughs Wellcome's Retrovir (AZT, zidovudine) found that average monthly enrollments in the reimbursement program declined by 41% from a mean of 88 before June to 52 after. Ontario funds Retrovir therapy for all HIV-positive residents of the province. "There has been a substantial reduction in the number of new enrollments in the [AZT] program in Ontario following release of the Concorde results," the poster concludes. The Anglo-French Concorde trial found no benefit to early initiation of Retrovir therapy in asymptomatic HIV-positive individuals ("The Pink Sheet" June 14, p. 11). The poster, entitled "After Concorde: Changes in the Initiation of Zidovudine Therapy in Ontario, Canada," was presented by Anita Rachlis, et al., Sunnybrook Health Sciences Centre, North York, Ontario. The decline in new enrollments was not limited to asymptomatic patients, the poster reported. In fact, enrollments of symptomatic patients declined by 52% compared to a 36% decline in asymptomatic patients. "This was unexpected since the Concorde trial only pertained to asymptomatic patients," the poster noted. The average CD4 cell count of new enrollees declined from 252/mm to 206 after Concorde. The decline in new ZDV enrollees was not stemmed by publication of a contradictory study in July that affirmed a benefit of early Retrovir therapy. "Despite publication of these findings, ZDV enrollments have remained low," the poster said. While the Ontario Retrovir population is relatively small (a total of 3,000 patients have been enrolled on zidovudine in the province since it was approved in Canada), Burroughs Wellcome has been seeing declines in the use of the drug worldwide. The company said Dec. 16 that sales of AZT "continue to suffer" as a result of "confusion caused to prescribers and patients" from preliminary reports of the Concorde study. The effect has been most marked in the U.S., the company said.

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