Malawi, 2019
Dr Gilles van Cutsem, HIV/TB adviser with Doctors Without Borders in South Africa, has this to say:
Cryptococcal meningitis is one of the main causes of death of people living with HIV, and while diagnostic tests and medicines for prevention and treatment exist, access in low- and middle-income countries is extremely limited. The results of the AMBITION trial make ending cryptococcal meningitis deaths by 2030 an achievable goal, but it is one we risk sacrificing if our patients can’t access L-AmB. Gilead must put lives before profits, implement its “access” price for L-AmB and do everything it can to secure global supply of this lifesaving drug.Dr Gilles van Cutsem, HIV/TB adviser
L-AmB is an essential medicine for the treatment of neglected tropical diseases such as visceral leishmaniasis and fungal infections including cryptococcal meningitis, the second-leading killer of people living with HIV after tuberculosis. Although it is the least toxic treatment available to treat cryptococcal meningitis, access to L-AmB in LMICs is extremely limited. This is primarily due to a reluctance to adopt the drug in treatment protocols because of Gilead’s high prices and limited registration, both of which fail to assure countries that Gilead will sustain a secured supply of L-AmB. In light of its recent increased use in the treatment of mucormycosis (black fungus) in patients with COVID-19, access to L-AmB has become even more difficult.
Quality-assured generic versions of L-AmB are urgently needed to increase treatment supply, and to lower prices through competition. Generic companies have been working for years to develop L-AmB and face multiple hurdles. Gilead has long hidden their liposomal technology – a key component of manufacturing L-AmB – as a trade secret, which combined with limitations on availability of raw materials and challenging regulatory pathways has significantly delayed generic competition.
In March 2017, organisations from 17 European countries filed an opposition to Gilead Science's patent on the highly effective hepatitis C drug sofosbuvir. On 13th and 14th of September 2018, the hearing took e place before the European Patent Office in Munich, Germany. Activists held a protest in front of the European Patent Office for affordable medicines at the start of proceedings on 13 September. © Peter Bauza
Today’s preliminary AMBITION trial results add further evidence for the need to scale up access to L-AmB and could be a gamechanger in the treatment of cryptococcal meningitis. Moving from a 7-day IV regimen to single high-dose of L-AmB, in combination with oral flucytosine and fluconazole, would make treating cryptococcal meningitis easier, whilst also reducing the major cost driver of hospitalisation. In addition, the single dose of L-AmB shows non-inferiority and reduced toxicity when compared with the current 7-day treatment. This simplification of treatment may also contribute to achieving the global goal of ending cryptococcal meningitis deaths by 2030. If WHO recommends this shortened treatment as the preferred first-line treatment for cryptococcal meningitis, this will require a significant increase in the supply of affordable L-AmB for the estimated annual 108,000 cases of cryptococcal meningitis globally.
According to Raef Makar, HIV Pharmacist, MSF Access Campaign:
It is shameful that people living with HIV in low- and middle-income countries have been waiting almost three years for Gilead to implement their promise to lower the price of the lifesaving drug L-AmB. Gilead must urgently implement its “access” price for every country in need. In addition, we urge Gilead to share publicly their calculations behind the “access” price, their drug registration footprint, and their manufacturing and supply capacities so to verify that they, as the key supplier of quality-assured L-AmB, are indeed able to fulfil the global demands for L-AmB for all diseases. People living with HIV and others who are in urgent need of this lifesaving drug cannot afford to spend any more time waiting on Gilead’s empty promises.Raef Makar, HIV Pharmacist
