Gilead Sciences have expanded their access initiative for AmBisome (a liposomal preparation of amphotericin B) to include cryptococcal meningitis, where previously it was only for leishmaniasis. Governments and public sector procurers in 116 low- and middle-income countries can now buy the drug at $16.25 per 50mg vial. Costs in other countries typically vary from $80 to $400. Gilead is also undertaking a number of activities to expand access to AmBisome for cryptococcal meningitis in high-burden countries, including expediting registration for this indication.
“The continuing toll of cryptococcal meningitis is a reminder that people living with HIV can still face life-threatening opportunistic infections because they do not receive antiretroviral therapy or are on suboptimal regimens. While we continue our efforts to expand access to HIV therapy, we also recognise the important role that AmBisome can play for people with cryptococcal meningitis,” said Gregg Alton, chief paitient officer at Gilead Sciences.
Amphotericin B (with flucytosine) is currently the initial treatment of choice for cryptococcal meningitis as it clears the brain of fungal cells faster than any other medication. Initially used in 1959, the standard dose in AIDS is 1 mg/kg, so about 50 mg daily. With a non-liposomal formulation, this costs around $10. Because liposomal amphotericin B has a very different overall body tissue distribution, a dose of 4-6 mg/kg daily is recommended for cryptococcal meningitis, so about 250 mg daily.
The main force behind this major price reduction has been the informal advocacy group CryptoMAG, led by Dr Angela Loyse of St George’s Hospital in London who is both a cryptococcal meningitis researcher and advocate for better care for patients with cryptococcal disease. CryptoMAG first met in Geneva in 2013, supported by GAFFI, and this meeting resulted in the addition of both amphotericin B and flucytosine to the World Health Organisation (WHO) Essential Medicines List.Life Organisation material