from Presentation 4, Norvir Community Update
PRACHAR: At this point, we would like to discuss our taste masking study.
We went to the Arthur D. Little consulting firm which has significant experience in taste
masking strategies for products that, after they were formulated, were not pleasant enough
for patients to take on a consistent basis. We know there are many anecdotes on how to
mask the taste of liquid Norvir. We decided to systematically go through all the categories
of options, and then, with all of the examples possible, identify what we found to be the best
things to help with the taste of Norvir in the interim. What I mean by categories is - do you
prime your mouth with an agent and then take the Norvir? Is that better than chasing it
with an agent after you swallow it? Is that better than mixing it with some other liquid form
and creating a higher volume of liquid that's diluted? Is that better than injecting it with
a syringe and squirting in the back of the throat, to bypass the taste buds? Those were
categories of options that we monitored or that we evaluated.
The consulting firm has a panel of experts - called an expert sensory panel - that tests
products and tolerability options for pharmaceutical and consumer products. They are not
quite wine connoisseurs, but they do this over and over again. So they started with the
flavor profile of Norvir. They analyzed all of the principal elements that make Norvir taste
the way that it does. They picked out specific attributes about the Norvir flavor profile.
They found the flavor unbalanced and the various flavor elements are not cohesive. They
identified a peppermint taste, a caramel taste, a medicine taste, and an alcohol bite. All
those things together create an unpleasant tasting product.
So what can we do, based on their expert opinion, to identify a reasonable set of options
that might mask this unpleasant taste, knowing what we know about these types of negative
attributes? That was step one. Step two was testing from 50 to 75 options that, based on
their experience, they thought might work well. They found out that many things that we
thought worked real well, didn't work so well. And some other things that we had a hunch
might work well for various reasons, did work well. What we ended up with was a list of
six products that we tested with HIV-positive patients that were taking Norvir to find out
which of the products helped mask the taste for them. And these are the results.
These are the top performing chasers from #1 to #4: Number 1 is Nutella hazelnut spread
which is somewhat like peanut butter, a little bit thinner in consistency, but with a chocolate
hazelnut spread on top of graham crackers. And just a side note, the consulting firm tried
to test products that are available globally, because we realize that these conclusions would
need to be applicable to a global audience. We also looked for things that would be
portable, meaning that they wouldn't have special storage requirements and might be able
to be carried easily. We also looked for diversity, in terms of if people are taking a dose at
breakfast and evening, we didn't want to just have foods that might be appropriate for the
end of day and no one would ever take for breakfast.
QUESTION: What are graham crackers?
DINTRUFF: It is a cookie, or a biscuit , with the consistency of a cracker. However,
it's sweeter than a cracker.
PRACHAR: And a rationale for it being globally available is that it is a Nabisco brand
name, which is a very global brand, and there are multiple others. That was the top one.
Number 2 was Riessen chocolate chew.
QUESTION: That's globally available?
QUESTION: In Canada?
PRACHAR: We can follow up specifically on a country-by-country basis, but we gave
the firm the charter to look at things that are globally available.
QUESTION: I think Riessen's are made by Nestle.
PRACHAR: Riessen's are made by Nestle, so that's reason to believe that they are are
available most places.
QUESTION: What do they look like?
PRACHAR: They are little chocolate squares that have the consistency of a little piece
of fudge. They are individually wrapped. So you can put them in your pocket and carry
them with you. What is important to remember is that this was an expert panel that picked
these products and then tested them with Norvir patients. Taste is a very individualized
thing. This study has statistical reliability in that we surveyed enough patients to believe
that this is a broadly generalizable list. But if you know for certain that other things have
worked with specific patients, do not tell them to discontinue what they are doing. Do
Number 3 is a simple oats and honey granola bar. We have all seen these. There are
several different brands that are individually packaged and very popular. Number 4 was
cracker sandwiches with peanut butter. Just simple tiny cracker sandwiches with peanut
butter in between. There are several brands. They are very popular and you can find them
in most vending machines. These are the top four products in global distribution that the
consultants and patients found most helpful.
DINTRUFF: You will know better than we will what works in a relatively short period
of time to mask the taste of Norvir in people in which the taste is a problem.