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Author Topic: diminishing returns in HIV  (Read 1336 times)

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Offline Jeff G

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diminishing returns in HIV
« on: July 09, 2015, 01:39:11 PM »
This is something to think about…

http://finance.yahoo.com/news/success-glaxos-hiv-unit-may-060000296.html

HIV drugs are proving to be so effective in containing the virus that GlaxoSmithKline Plc foresees a time, a decade away, when its most profitable business unit may no longer have a purpose.

“There are diminishing returns in HIV,” said David Redfern, Glaxo’s chief strategy officer and the chairman of its AIDS treatment unit ViiV Healthcare Ltd. “The industry has done a fantastic job of taking the fear of the late ’80s, and the death sentence, and taking that to one tablet a day.”

As ViiV’s and market leader Gilead Sciences Inc.’s drugs get better at defeating HIV, there may not be much more room for improvement short of delivering an actual cure,

Offline zach

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Re: diminishing returns in HIV
« Reply #1 on: July 09, 2015, 01:56:36 PM »
my knee jerk reaction... cry me a fkn river for the woes of big pharma

little more thought, if there is no profit to manufacturing drugs... where dafuq am i gonna get my meds from?

their profits are insane, in my mind it's criminal... but they got me by the balls

i hope before i die i can just walk into a local pharmacy and pick up some generic meds to effectively treat this virus

Offline leatherman

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Re: diminishing returns in HIV
« Reply #2 on: July 09, 2015, 02:21:14 PM »
Interesting

I've often talked about a similar scenario but based on a vaccine being developed. If the vaccine was therapeutic (meaning it would also help people already infected to be functionally cured or reduce their treatment burden) that would be one thing. But if the vaccine only helps those NOT infected, then we pozzies will, as we have always been, quite literally a dying breed. I can imagine cure, treatment and care funding all drying up, leaving thousands of us high and dry for a long time during our senior years.

This article seems to suggest the tipping point is coming where the meds are perfected as well as they can be making it no longer cost efficient for pharmaceuticals to continue research on creating new drugs or refining any further the drugs we already have.

ugh. but that sort of thinking is what I do. Much to the chagrin of a lot of my fellow HIV advocates in my state, I'm a chicken-little sky-is-falling kind of guy. I remember when nobody cared about us, and I can always imagine a time like that coming back around. Sadly only afew fellow advocates understand and agree on this kind of big-picture view. I'm just afraid that when they start not caring or worrying about PLWH again, it'll be at a time when there is no cure yet, and PLWH will lose a lot of health care. I worry about these things a lot in a Red state with no expanded Medicaid, and raging poverty and health care disparities.
leatherman (aka mIkIE)

So we put our hands up like the ceiling can’t hold us
"Can't Hold Us" - Macklemore & Ryan Lewis

chart from 1992-2015 Reyataz/Norvir/Truvada

Offline Almost2late

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Re: diminishing returns in HIV
« Reply #3 on: July 09, 2015, 06:40:18 PM »
Thought they might come up with that injection you take every 3 months before they call it quits, No?  :-\ .. then at least I wouldn't have to worry if I took my hiv meds no more..
I can imagine cure, treatment and care funding all drying up, leaving thousands of us high and dry for a long time during our senior years.
more like millions I think..
Quote
I'm just afraid that when they start not caring or worrying about PLWH
What's PLWH?

Really am pretty comfortable and grateful with my working one a day pill but sometimes I do worry about the supplies drying up.. Don't like being at the mercy of the drug companies but then again so are many people with other illnesses right? 
 

Offline Jeff G

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Re: diminishing returns in HIV
« Reply #4 on: July 09, 2015, 06:51:43 PM »
people living with HIV

Offline zach

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Re: diminishing returns in HIV
« Reply #5 on: July 09, 2015, 06:51:56 PM »
PLWH and PLWHA

persons living with hiv/aids

edited to add an echo echo echo.... :)


Offline Almost2late

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Re: diminishing returns in HIV
« Reply #6 on: July 09, 2015, 06:58:12 PM »
people living with HIV
Oh. thanks

Offline MitchMiller

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Re: diminishing returns in HIV
« Reply #7 on: July 10, 2015, 01:02:55 AM »
Time will tell because Sustiva goes off patent soon.  Then you have a very potent combo that is fully generic:  Sustiva, Abacavir, Epivir.  GILD used a very expensive option they bought from another drug company to push their new combo forward faster through the FDA approval process.  I believe they are racing not only against ABBV (triumeq) but also against Sustiva's patent expiration.

The ENCORE1 study demonstrated that the 600mg dose for Sustiva can be safely reduced to 400mg.  However, the study said there were no differences in AE's.  But I am slowly finishing up my supply of 600mg Sustiva by taking Sustiva 600mg every three days, and 400mg the rest of the time.  I can really feel the difference.  So that generic regimen could prove to be a big competitor if insurance companies push patients to go that route, especially if the reduced dose catches on. 
« Last Edit: July 10, 2015, 01:09:53 AM by MitchMiller »

Offline geobee

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Re: diminishing returns in HIV
« Reply #8 on: July 10, 2015, 01:09:07 AM »
I don't see this is as a negative. The incentives are coming down for new drugs, but we've got some great drugs now.  1 non-refrigerated pill a day = no problem.

Now, all of the financial incentives are towards curing the damn thing.  Because you can't make money any more by *just* keeping people alive. 

Think of the Hep C drugs -- Solvadi, Harvoni, etc.  They cost $100K.    Hep C was once considered incurable and now, for a steep price, you can be cured.  I think one day they'll be a super-expensive cure for HIV too.  Maybe so expensive that some of us will just keep taking the daily pill!


Offline MitchMiller

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Re: diminishing returns in HIV
« Reply #9 on: July 10, 2015, 01:15:49 AM »
It raises the bar.  To make money, you will need to go beyond just an improvement to the existing treatment paradigms.   

The holy grail to drug companies would seem to be a cure that does not render immunity to re-infection.
« Last Edit: July 10, 2015, 01:18:15 AM by MitchMiller »

Offline leatherman

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Re: diminishing returns in HIV
« Reply #10 on: July 10, 2015, 09:28:24 AM »
To make money, you will need to go beyond just an improvement to the existing treatment paradigms.   
Because you can't make money any more by *just* keeping people alive. 
in the US alone:
($3k a month X 1.5 million currently infected) + ($3k a month X 36k* new patients every year)
*(50k newly infected every year - 14k people who die of AIDS every year)


they need to do what to keep making money??
Seems likes the current scheme of things is pretty lucrative. ;)
leatherman (aka mIkIE)

So we put our hands up like the ceiling can’t hold us
"Can't Hold Us" - Macklemore & Ryan Lewis

chart from 1992-2015 Reyataz/Norvir/Truvada

Offline geobee

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Re: diminishing returns in HIV
« Reply #11 on: July 10, 2015, 01:42:03 PM »
Once those drugs come off patent, cheap generics will fill the gap.  Prices will drop fast.

Offline vertigo

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Re: diminishing returns in HIV
« Reply #12 on: July 10, 2015, 02:06:12 PM »
I think the drug company profits are assured for quite a while.  Look at how the rollout of TAF has been timed to supplant TDF, thereby enabling new formulations of Truvada and many other combos.  How many doctors/patients are going to consent to prescriptions of older generics when newer, better drugs are available?  The new drugs will have patent protection for many years into the future.  The same thing with generic Atripla.  If you're on a new, integrase-inhibitor based regime, would you really want to switch to Sustiva?  No thanks.  Patients on public assistance might not have the leverage to get the best drugs, but I don't see that happening if you have private insurance.

Nonetheless, the article is interesting as it points out the hard economics behind so many of our health care advances.  It is a big, profitable business after all.

Offline wolfter

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Re: diminishing returns in HIV
« Reply #13 on: July 10, 2015, 02:24:04 PM »
When the vast majority are well controlled on relatively easy combos, there's no financial incentive to continue in the research for treatments.  All organizations utilize the concept of diminishing return for research and development.  Creating new drugs will not increase overall profit.

There will be the same number of subscribers so why invest billions?  Think of it like this;  if a company has 1000 customers who need their product, they can count on that customer base.  If they spend $10,000 dollars on R&D that only benefits that customer base, where is the financial incentive?  The customers who choose the new product will immediately lessen the number using the previous product.

Written as a true former federal cost accountant/analyst.  :)
Being honest is not wronging others, continuing the dishonesty is.

Offline titik

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Re: diminishing returns in HIV
« Reply #14 on: July 10, 2015, 03:06:02 PM »
What happens when the (current) drug resistant strains becomes more prolific though?

Offline wolfter

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Re: diminishing returns in HIV
« Reply #15 on: July 10, 2015, 03:17:35 PM »
What happens when the (current) drug resistant strains becomes more prolific though?

Then we'll return to teaching the message of personal responsibility and advocating for people to make their sexual health a priority?
Being honest is not wronging others, continuing the dishonesty is.

Offline OneTampa

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Re: diminishing returns in HIV
« Reply #16 on: July 10, 2015, 09:50:43 PM »
Posted on similar topic several years ago.

Link:

http://forums.poz.com/index.php?topic=48039.msg583309#msg583309


____________________________________________________________________

And this post from me a few years ago:

The pharma's noble aim is for people to "live" while paying for the medicines they need to stay alive.  After all, you can't dip into your coin clutch when you are dead.

Here is the Pharma Business 101 plan:

>Treatment = Outlay for ongoing (lengthy) medicine costs, adjusted for maximum profit.

>Cure = Outlay for potentially shorter medicine costs, adjusted for maximum profit. 

I think though that there is a favorable evolutionary wildcard stepping up coming from various natural human genetic response discoveries.
« Last Edit: July 10, 2015, 10:00:22 PM by OneTampa »
"He is my oldest child. The shy and retiring one over there with the Haitian headdress serving pescaíto frito."

Offline MahmoudK

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Re: diminishing returns in HIV
« Reply #17 on: July 11, 2015, 02:45:51 AM »
Just a curious thought, when do you think some of these drug will come off patent? Like, how do you people know these patent's are ending soon?

Offline xasxas

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Re: diminishing returns in HIV
« Reply #18 on: July 11, 2015, 06:29:32 AM »
Just a curious thought, when do you think some of these drug will come off patent? Like, how do you people know these patent's are ending soon?

The article below has a table with some of the drugs that have and are coming off patent.  These drugs are the constituents of the combination therapies we use.

http://www.nature.com/news/generic-hiv-drugs-will-widen-us-treatment-net-1.11173

One of the bigger drugs coming off patent soon is Atripla and is as such:

http://www.drugpatentwatch.com/ultimate/tradename/ATRIPLA

Mind you can get generics for many patented drugs if you live in a developing country.

Offline MitchMiller

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Re: diminishing returns in HIV
« Reply #19 on: Yesterday at 04:50:53 AM »
Once Sustiva comes off patent, it will open up the generic market to combos of three pills that can be taken once daily that are as efficacious as Atripla.   

Personally, I don't see any difference between taking one pill daily vs two or three pills once daily.

The big problem is that generic drugs in the US still cost three to five times what they cost overseas.  I'm not sure why, but US generics are far more expensive than online prices of the Cipla equivalents (and Cipla drugs are FDA approved for PEPFAR).

Offline xman

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Re: diminishing returns in HIV
« Reply #20 on: Yesterday at 01:55:57 PM »
Gilead has started investing in drugs that attack the latent reservoir. Look at the pipeline. They have one candidate in phase 1 clinical trials. The forecast is that in the next 5-10 years new drugs are designed to target latently infected cells. Big Pharma is investing in cure research for making even more money on the next generation of drugs able to the destroy the reservoir. A cure is much more profitable as actual therapy. People get cured and perhaps reinfected. This allows to make profit on single persons on a repeated basis. A cure is not a preventive vaccine.
sign the petition launched by the aids policy project addressed to the nih aimed to increase the money needed to find the cure:

http://www.aidspolicyproject.org/petition_for_the_nih

we can make a difference and we need to fight. please support them! it doesn't cost you anything. they need it now more than ever!

Offline geobee

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Re: diminishing returns in HIV
« Reply #21 on: Yesterday at 08:28:36 PM »
For me, 1 pill a day means only 1 co-pay.  It's actually cheaper for Kaiser to buy the three drugs instead of supplying me with the one drug (Stribild).  But because it's only 1 copay for me I go with the Stribild.

 


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