[HN Gopher] How remdesivir works, and why it's not the ultimate ...
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How remdesivir works, and why it's not the ultimate coronavirus
killer
Author : chmaynard
Score : 72 points
Date : 2020-06-29 20:17 UTC (2 hours ago)
(HTM) web link (scopeblog.stanford.edu)
(TXT) w3m dump (scopeblog.stanford.edu)
| redis_mlc wrote:
| If I was going to choose a potion, I think I'd stick with garlic.
| Old-school, but can be labelled organic in 2020.
|
| You should check out the Youtube videos on plague in the 1500's.
| Exactly like the response to corona today - it's eerie.
|
| Just like China welded residents in their apartments, they used
| to nail your doors shut. Oh, and the 1%ers ran for the hills,
| too.
| kens wrote:
| There's a nice diagram from _Science_ that shows how Remdesivir
| and other potential anti-coronavirus drugs work:
| https://science.sciencemag.org/content/sci/368/6493/829/F1.l...
| acqq wrote:
| The picture is from
| https://science.sciencemag.org/content/368/6493/829 published
| "22 May 2020" at the time when less was known about Chloroquine
| and hydroxychloroquine than today about treating Covid-19 (1).
| That's the needed perspective when watching the picture, where
| the rest is still relevant.
|
| -----
|
| 1)
|
| E.g. June 23, 2020 "NIH: Trial Investigating Hydroxychloroquine
| for COVID-19 Stopped"
|
| https://www.empr.com/home/news/hydroxychloroquine-trial-halt...
|
| 17 June 2020 ""Solidarity" clinical trial"
|
| https://www.who.int/emergencies/diseases/novel-coronavirus-2...
|
| "hydroxychloroquine does not result in the reduction of
| mortality of hospitalised COVID-19 patients, when compared with
| standard of care."
|
| And before, Jun. 9, 2020: "Three big studies dim hopes that
| hydroxychloroquine can treat or prevent COVID-19":
|
| https://www.sciencemag.org/news/2020/06/three-big-studies-di...
| gmantg wrote:
| If it costs $1M, I'd rather pick the WC virus.
| smeyer wrote:
| It looks like it will cost a few thousand dollars [0]. What
| does WC in "WC virus" stand for?
|
| [0] https://www.cbsnews.com/news/gilead-coronavirus-treatment-
| re...
| qzw wrote:
| Presumably "Wuhan Corona"? I don't know if that's common
| nomenclature in his circle or just idiosyncratic.
| malwarebytess wrote:
| Wuhan China I'm sure. Poster's objective is probably not to
| different from those who insist on "China Virus."
| GuB-42 wrote:
| It doesn't cost a million. But me too, I will pick the virus
| over the million. Obviously because I don't have the million
| but with a massive loan for the rest of my life, it may not be
| impossible. So time to pull out the micromorts.
|
| Case fatality rate for COVID-19 is estimated to be about 1.4%
| (still uncertain). That's 14000/1000000 chance of death, or
| 14000 micromorts.
|
| Studies in the US have shown that people are ready to pay ~$50
| per micromort. If we assume that remdesivir really is the
| ultimate coronavirus killer, it means that following
| statistics, people would pay $700k for it. Not that far off
| from your million.
|
| In reality, safety standards in the US put the micromort at
| around $10, so that miracle cure would be about $140k.
|
| Of course, it is just general statistics, a wealthy old man
| will pay much more than a poor kid (risk of death increase with
| age). It assumes remdesivir is a miracle cure, which isn't, we
| are not sure if it is effective at all.
|
| In reality, it looks like treatment is going to be around
| $3000, which, if it improves my chances of survival by a few
| percent, is actually a sensible price.
| perl4ever wrote:
| >In reality, it looks like treatment is going to be around
| $3000, which, if it improves my chances of survival by a few
| percent, is actually a sensible price.
|
| But will you pay $3000 for _each and every_ thing that
| improves your chance of survival by a few percent?
| GuB-42 wrote:
| Definitely not when put that way, but it is actually not
| that far fetched. For example, spending $3000 more for a
| safer car is not uncommon. Insurance premiums, cost of
| installing guard rails on your balcony or securing your
| electrical installation, buying protective equipment,
| etc... Plus what you pay so that the government can make
| roads safer, to have water that is safe to drink and food
| that is safe to eat, etc... That's a lot of $3000 in the
| end.
| nickff wrote:
| How much does a seatbelt improve your chances of survival
| on the average car trip (not just the ones with accidents)?
| What about airbags?
| Dylan16807 wrote:
| A seat belt looks like it's worth a few micromorts per
| thousand miles, and they cost less than $50 per seat. A
| great bargain. Airbags give you diminishing returns on
| top of that, while costing almost 4x as much, but even if
| you estimate 1/10th the effectiveness of the seatbelt
| you're still looking at dozens of micromorts over the
| lifetime of a vehicle: worth it.
|
| But $3000 for a percentage chance of a percentage chance
| is a lot tougher to argue for repeatedly.
| pazimzadeh wrote:
| Nucleoside analogs are notorious for breeding resistance, which
| is why they should ideally be used in combo with other drugs.
| SomeoneFromCA wrote:
| I am wondering, Wikipedia claims that the active metabolite of
| this drug is a medicine for cats sold on black market; what is
| the price? I am sure it is way less than the ridiculous price
| they want for Remdesivir.
| catalogia wrote:
| Black market cat drugs? Do you have a death wish or something?
| kinkrtyavimoodh wrote:
| A chemical is a chemical. And people close to dying can be
| desperate.
| lisper wrote:
| People using fish antibiotics on themselves is a thing:
|
| https://www.thebugoutbagguide.com/fish-antibiotics-for-
| human...
| SomeoneFromCA wrote:
| Sometimes you have no choice, I guess.
| roywiggins wrote:
| Apparently as much as $12,000 for a 12-week course.
|
| https://www.theatlantic.com/science/archive/2020/05/remdesiv...
|
| Gilead is charging less than that for Remdesivir.
|
| https://www.cbsnews.com/news/gilead-coronavirus-treatment-re...
| sudosysgen wrote:
| They used to be quite a bit cheaper, around 600$ for an 8
| week course.
|
| The price increase is concerning.
| SomeoneFromCA wrote:
| I was wrong then. So cat owners should start buying
| remdesivir then.
| ethbro wrote:
| > So cat owners should start buying remdesivir then
|
| Yes! For many reasons.
|
| https://www.cdc.gov/media/releases/2020/s0422-covid-19-cats
| -...
| vikramkr wrote:
| The price they're asking is pretty reasonable. A couple
| thousand bucks for a few percent increased chance of survival
| is well below the benchmark set by drugs in less public disease
| areas. If this was a cancer drug they'd be charging an order of
| magnitude more.
|
| Edit:
|
| ICER, which is a drug price watchdog, suggested using a value
| added analysis that the max price remdesivir could justify was
| 4500[1]. ICER is not pharma's friend, and they dont usually end
| up suggesting a max price twice what the pharma company
| charges[2].
|
| [1]https://icer-
| review.org/announcements/alternative_pricing_mo...
|
| [2]https://www.fiercepharma.com/pharma/parp-drugs-from-az-
| clovi...
| fennecfoxen wrote:
| It's not just a good deal for survival, either, it's worth an
| accounting profit to the hospitals:
|
| > On average, the drug should help reduce hospital costs by
| $12,000 a patient, said [Chief Executive Daniel O'Day].
| Gilead estimated the savings based on data showing that each
| day of hospitalization costs $3,000 and that patients taking
| remdesivir are discharged four days sooner than those
| receiving standard treatment, Mr. O'Day said.
|
| https://www.wsj.com/articles/covid-19-drug-remdesivir-to-
| cos...
| remote_phone wrote:
| The biggest problem with remdesivir is that it is administered
| intravenously. That makes it very hard to administer unless the
| patient is in the hospital. What would be ideal is if they had it
| in pill form, and then anyone with early symptoms could get pills
| instead. But without that option right now it makes it too late
| to administer unless the patient is already in severe condition.
|
| They are planning on testing an inhalant version but who knows
| where that will land in terms of effectiveness. It might make
| things worse so that is much further out unless things are really
| lucky, which we haven't had a lot of with coronavirus.
| Icathian wrote:
| Home infusion medicine is a fairly big, and growing, option in
| the States. A drug being IV is definitely inconvenient, but
| there are some options.
| claudeganon wrote:
| IIRC, Gilead has tried to pull this drug off the shelf as a cure
| multiple times, for different diseases, only to have it proven to
| not be very efficacious.
|
| As soon as they announced it as a COVID treatment, I assumed it
| was another cash grab while people are confused, desperate, and
| scared.
| s1artibartfast wrote:
| That seems like a pretty cynical take. My understanding is that
| Gilead has been donating the drug and provided a royalty free
| license to other pharma companies to manufacture it (not that
| they could).
| claudeganon wrote:
| They just announced something like a 7K per treatment price
| schedule for the drug, and it was largely developed at tax
| payer expense through a DoD scheme, so I'll stick to my
| skepticism. The WHO also accidentally released some study
| data showing that drug showed no improvement in COVID
| outcomes:
|
| https://www.statnews.com/2020/04/23/data-on-gileads-
| remdesiv...
| ethbro wrote:
| The financial justification for antivirals is terrible,
| given alternatives. Hence why we have so few.
|
| So whether the DoD or whatever government branch catalyzed
| progress doesn't matter much to me.
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(page generated 2020-06-29 23:00 UTC)