Diplomatic immunity
The most important news in healthcare: Tuesday, April 21st
Good morning. Today we’re covering the efficacy of antibody testing for COVID-19, an announcement about free insulin, and a new combination treatment for kidney cancer.
How good is coronavirus antibody testing?
The pulse:
New York and other major cities have begun aggressive antibody testing to determine who has been infected and who has recovered from the coronavirus. But it’s unclear how reliably these results can be used to ensure public safety and restart the economy.
What is an antibody?
Antibodies are the body’s way of remembering infections. Each antibody is a protein that is specific to an invader and allows a patient to mount a faster, better immune response the next time their body sees that invader.
What is the status of antibody testing for the coronavirus?
Though the FDA has only validated four tests for use, they have allowed roughly 90 companies to sell tests in the U.S. The accuracy of these tests is questionable. In Laredo, Texas for example, it was found that 20,000 tests advertising a 95% accuracy were only right 20% of the time. Great Britain paid $20 million for 2 million tests from China, which are now gathering dust after they were found ineffective. Even tests explicitly cleared by the FDA can falsely diagnose 5% of patients as antibody-positive.
If someone actually does have antibodies, does this mean they can’t get reinfected?
Experts expect, based off of the behavior of similar infections, that patients infected with the coronavirus will have enough antibodies to protect them against it for at least a year. It’s also possible that people with more severe infections will be protected for longer. The problem is that the virus is so new: survivors from early weeks of infection in China have only been healthy for three months. And it’s still unclear whether having antibodies prevents transmission.
There have been anecdotes of coronavirus reinfection, but experts largely chalk these up to testing error or lingering traces of the prior infection.
Bottom line it for me.
In theory, antibody testing can help us identify who is immune to the coronavirus in the near-to-mid term. But it’s not yet nearly reliable enough to drive large-scale public health decision-making.
Photo source: diabetes.co.uk
Pharma companies cut insulin costs for patients
The pulse:
Last week, pharma giant Novo Nordisk announced that they are offering insulin for free for 90 days to patients who have lost private health insurance due to job loss. This follows a similar patient assistance program launched earlier this month by Eli Lilly.
Is this just a push for goodwill from these companies?
That’s probably a factor. Drug pricing, and insulin pricing specifically, have been hot-button issues for several years. The price of insulin has risen 1200% since 1996, forcing 13% of America’s 30 million patients with diabetes to skip dosages, take fewer dosages, or delay filling a prescription in an effort to save money. A quarter of diabetic patients have asked doctors for a lower-priced insulin alternative.
What’s the reaction?
Mixed. Kelly Close, the founder of the diatribe Foundation, an advocacy group for diabetics, called the decision “absolutely critical.” Allison Bailey, a spokesperson for T1 International, a Type 1 diabetes charity, was less complimentary:
Novo Nordisk’s announcement, just like Eli Lilly’s announcement last week, demonstrates once again that the insulin manufacturers have always had the power to do more to alleviate patient suffering. The COVID-19 crisis and economic fallout have caused massive upheavals in the daily lives of Americans, but patients with diabetes have been in crisis for several years now.
What’s the bottom line?
Novo Nordisk has made insulin as cheap as possible for uninsured diabetics, but some patient advocates believe it’s too small a concession in a larger pricing war.
New Combination Therapy for Kidney Cancer Reduces Risk of Death by 40%
The pulse:
On Monday, the combination of chemotherapy drug Cabometyx and immunotherapy drug Opdivo was shown to reduce risk of death from kidney cancer by 40%. Kidney cancer kills 15,000 Americans each year.
Okay, I’ve heard of chemo. But what’s immunotherapy?
Immunotherapy has been hailed in recent years as the future of cancer treatment. It works by revving up the body’s natural immune response so that patients can better fight off cancer cells themselves.
So like when I take a ton of Emergen-C?
A little bit stronger than that. Opdivo, manufactured by Bristol-Myers Squibb, blocks a protein called PD-1, which cancer cells use to put a “brake” on the immune system. When PD-1 is blocked by Opdivo, it allows the immune system to hit the gas pedal and better detect and attack the tumor.
Why did the trial need to use chemotherapy and immunotherapy?
Cabometyx, the chemotherapy manufactured by Exelixis, has been approved and in use since 2016 for the treatment of advanced stage kidney cancer. But a different chemotherapy-immunotherapy combination called Keytruda-Inlyta was approved for kidney cancer last April. Exelixis has now demonstrated that Cabometyx can also be successfully combined with immunotherapy and can compete with Keytruda-Inlyta.
Which combination is better?
It’s hard to say, because it’s difficult to compare data from different clinical trials, but the two seem similar. In its trial, Keytruda-Inlyta showed a 31% reduction in cancer progression and a 47% reduction in the risk of death as compared to standard of care. Meanwhile, Cabometyx-Opdivo showed a 49% reduction in cancer progression and a 40% reduction in risk of death.
Final Thoughts:
This is huge news for Exelixis, whose kidney cancer therapy was starting to be overshadowed. Shares jumped 25% on Monday.
Rapid Fire
Novartis has announced that it will be starting a 450 person clinical trial to study the use of anti-malarial drug hydroxychloroquine for COVID-19. Though some smaller studies have suggested hydroxychloroquine may not be effective for coronavirus, the Swiss drug giant argues that a rigorous trial is necessary to help scientists come to definitive conclusion.
A new insomnia drug could be a game changer for the 9 million Americans who currently use sleep aids. In a new study, patients taking daridorexant fell asleep easier and reported fewer the side effects than those often seen in similar drugs.
Primary care physicians are not currently allowed to prescribe methadone, a common treatment for opioid addiction. Many patient advocates would like this to change, but a new survey reveals that most primary care physicians do not actually want to treat opioid use disorder, possibly due to discomfort and unfamiliarity with the disease.
Thanks for reading!
We’ve been receiving lots of questions about stories in the Pulse, so starting this Friday, we’ll be devoting a section to answering them. If you’re curious about coronavirus reinfection, insulin prices, PD-1s, or anything else healthcare-related, drop your questions here.
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Until Friday,
Mrinal and Serena