We need COVID-19 treatments ASAP — but a perverse incentive could slow pharma breakthroughs (Mother Jones)

Gilead, the company behind the promising antiviral remdesivir, had two blockbuster HIV medications. Here’s what happened.

In the flood of bad news about the coronavirus, this week there was a buoy: A major clinical trial showed that an antiviral medication called remdesivir shortened the length of time that patients are sick with COVID-19, from an average of 15 days down to 11. The FDA had already rushed to approve research on the compound — an underperforming Ebola drug — and the agency is expected to authorize it for emergency use within a week. There are caveats: It’s not clear whether the drug reduces a patient’s risk of dying from the disease, and a small Chinese study showed no benefit. Still, doctors are hopeful that remdesivir will help reduce strain on hospitals and buy time for researchers to develop other treatments and a vaccine. In the meantime, remdesivir’s manufacturer, the pharmaceutical company Gilead, could save millions of lives and make billions of dollars.

That’s how it’s supposed to work in the pharma world: Profit spurs innovation. But it doesn’t always happen that way. In fact, sometimes the opposite is true. Because of the perverse incentive structure of medical patents, Gilead has made billions of dollars by delaying development of its own HIV medication for the people who need it.

In the late 1990s, Gilead made a breakthrough in HIV treatment when it found that the molecule tenofovir disoproxil fumarate, or TDF, could stop HIV from replicating. In 2005, Gilead’s TDF-based drug Truvada made $570 million in sales, and $2.7 billion in 2010. TDF’s side effects — decreased kidney function and bone mass — were milder than those of rival drugs, and seemed a small price for turning a death sentence into a chronic illness.

But as TDF made Gilead an industry titan, another molecule waited in the wings. In 2001, Gilead researchers found that tenofovir alafenamide, or TAF, was 10 times more effective than its cousin TDF, and likely had the same therapeutic effect at smaller, less-toxic doses. Yet months after submitting Truvada to the FDA, Gilead halted TAF research for six years, according to lawsuits filed by Truvada patients who suffered severe side effects from the drug. As TAF lay dormant, Gilead launched new treatments based on TDF that, from 2004 to 2014, made $60 billion in sales…

To read the entire article from Mother Jones, click https://www.motherjones.com/politics/2020/05/we-need-covid-19-treatments-asap-but-a-perverse-incentive-could-slow-pharma-breakthroughs/


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