FDA Approved A Second PrEP Drug
There is now a better option than Truvada in preventing HIV transmission.
This past Thursday, the Food and Drug Administration gave final approval of a second drug from Gilead Sciences for PrEP (or pre-exposure prophylaxis). In 2012, Truvada was approved for use as PrEP (a daily pill that has a concept somewhat like the pregnancy pill. Only in this case, the pill prevents HIV infection and not pregnancy).
Now, the FDA has approved of Gilead’s Descovy drug being used for PrEP as well. Since 2016, Descovy has been used to treat people already infected with HIV and limit the spread of the disease. And now, Descovy can be used as another option of the daily PrEP pill.
“Descovy for PrEP provides a new HIV prevention option that matches Truvada’s high efficacy with statistically significant improvements in renal and bone safety, which can be an important consideration as people at risk increasingly use PrEP for longer periods of time,” Gilead CEO Daniel O'Day said in a statement.
In Descovy’s case, clinical trials have proven that the pill will be less toxic to the kidneys and bones. Descovy is also more effective than Truvada in preventing HIV transmission. Keep in mind, Truvada was already 92% to 99% effective in reducing the risk of HIV infection.
The Business Side
Now let's be honest and pragmatic about this situation. This makes total sense for Gilead and its business savvy ways. While we would hope that healthcare was the most important factor of healthcare… it’s not. The most important factor is making money. And soon, Gilead will be making much less of it on Truvada alone.
Gilead’s patent on Truvada is set to expire in 2020. While Reuters reports that Truvada made Gilead $2.6 billion in 2018, that number is expected to drop by 2024 to a “mere” $428 million. That’s because the loss of a patent means that there will several cheap generic drugs being made and sold. And with the U.S. health market being what it is for the average citizen (stifling, lifesucking, and bank account breaking), a cheaper option is often a better option.
With that in mind, it’s no surprise that Gilead fought for a newer, more effective, and more expensive option. Sales for Descovy are expected to double by 2024 from the $1.2 billion it was last year to $3 billion.
Who Can, Can’t, & Might Use Descovy
That said, there are some good sides to the story. Thanks to the Trump administration’s proposed plan to end the HIV epidemic by 2030 (despite losing HIV specialists who quit out of moral principle or rerouting money originally for HIV research), Gilead has announced plans to donate its most up-to-date PrEP medication.
Now that Descovy fits that description, 200,000 uninsured people will receive Descovy from Gilead for the next 11 years. This will almost match the estimated 213,000 people who were prescribed to Truvada for use as Prep in the second quarter of 2019.
But the new and improved drug isn’t for everyone, unfortunately. Only men and transgender women will have access to the new HIV prevention pills. That’s because people who identified as female at birth were poorly represented in early research. As such, more research is needed to make sure that the drug is safe for them to use.