Last update 05 Nov 2024

Idelalisib

Last update 05 Nov 2024

Overview

R&D Status

Clinical Result

Translational Medicine

Overview

Basic Info

Drug Type

Small molecule drug

Synonyms

5-Fluoro-3-phenyl-2-((S)-1-(9H-purin-6-ylamino)-propyl)-3H-quinazolin-4-one, 5-fluoro-3-phenyl-2-[(1S)-1-(3H-purin-6-ylamino)propyl]quinazolin-4(3H)-one, IDELA

+ [4]

Target

PI3Kδ

Mechanism

PI3Kδ inhibitors(Phosphatidylinositol 3 kinase delta inhibitors)

Therapeutic Areas

NeoplasmsImmune System DiseasesHemic and Lymphatic Diseases+ [2]

Active Indication

Chronic Lymphocytic LeukemiaFollicular LymphomaSmall Lymphocytic Lymphoma+ [3]

Inactive Indication

Acute Myeloid LeukemiaB-cell lymphoma refractoryDiffuse Large B-Cell Lymphoma+ [14]

Originator Organization

Gilead Sciences, Inc.

Active Organization

Gilead Sciences Ireland UC

Gilead Sciences, Inc.

Gilead Sciences Canada, Inc.

Inactive Organization-

Drug Highest PhaseApproved

First Approval Date

US (23 Jul 2014),

Chronic Lymphocytic LeukemiaFollicular LymphomaSmall Lymphocytic Lymphoma

RegulationBreakthrough Therapy (US), Orphan Drug (US), Fast Track (US)

Structure

Molecular FormulaC22H18FN7O

InChIKeyIFSDAJWBUCMOAH-HNNXBMFYSA-N

CAS Registry870281-82-6

Clinical Trials associated with Idelalisib

NCT05725200 / RecruitingPhase 2IIT

Study to Investigate Outcome of Individualized Treatment Based on Pharmacogenomic Profiling & Ex Vivo Drug Sensitivity Testing of Patient-derived Organoids in Patients With Metastatic Colorectal Cancer

The purpose of the study is to investigate the effect and side effects of personalized cancer treatment in patients with metastatic colorectal cancer (bowel cancer). All patients included must have metastatic bowel cancer and receive or have received at least two lines of standard chemotherapy. The cancer must not be available for surgery with curative intent.

Start Date27 Sep 2022

Sponsor / Collaborator

Oslo universitetssykehus HF

NCT03878524 / TerminatedPhase 1IIT

Serial Measurements of Molecular and Architectural Responses to Therapy (SMMART) Trial: PRIME

This phase Ib trial determines if samples from a patient's cancer can be tested to find combinations of drugs that provide clinical benefit for the kind of cancer the patient has. This study is also being done to understand why cancer drugs can stop working and how different cancers in different people respond to different types of therapy.

Start Date01 Apr 2020

Sponsor / Collaborator

OHSU Knight Cancer Institute

[+1]

NCT03890289 / TerminatedPhase 2IIT

Idelalisib Plus Obinutuzumab in Patients With Relapsed/Refractory Follicular Lymphoma: a Phase 2, Single-arm, Multicentric Study

Single arm, prospective, multi-centric, phase II study. Patients with histologically confirmed follicular lymphoma, in need of a systemic approach and failing (i.e. with refractory disease [no response or response lasting less than 6 months at any previous line of treatment] or with a proven disease relapse) at least 2 previous lines of treatment, including any antibody directed against the CD20 antigen-containing chemotherapy, will undergo a combined chemo-free treatment with obinutuzumab and idelalisib.

Start Date18 Oct 2019

Sponsor / Collaborator-

100 Clinical Results associated with Idelalisib

100 Translational Medicine associated with Idelalisib

100 Patents (Medical) associated with Idelalisib

798

Literatures (Medical) associated with Idelalisib

01 Nov 2024·EUROPEAN JOURNAL OF PHARMACOLOGY

The efficacy and safety of PI3K and AKT inhibitors for patients with cancer: A systematic review and network meta-analysis

Review

Author: Xun, Fanghua ; Song, Aigang ; Hui, Fuhai ; Wang, Chengkang ; Xu, Ziang ; Ren, Tianshu ; Wang, Shuai ; Xu, Chang ; Hou, Shanbo ; Zhang, Yingshi ; Zhao, Qingchun ; Zheng, Fangyuan ; Xu, Xiangbo ; Geng, Hefeng ; Zhang, Tianqi ; Yang, Kaisi

BACKGROUND:

Inhibiting PI3K/AKT pathway activation may hinder the occurrence and progression of cancer. The aim of this study was to evaluate the efficacy and safety of the PI3K/AKT inhibitors and determine the most appropriate inhibitor for different cancer types.

METHODS:

Electronic databases up to June 2024 were used to examine the efficacy and safety of PI3K inhibitors (alpelisib, copanlisib, duvelisib, and idelalisib) and AKT inhibitors (capivasertib, ipatasertib and MK-2206) for the treatment of cancer. Data was assessed with a random-effect pairwise and network meta-analysis. Randomized controlled trials and retrospective studies were eligible if they compared PI3K or AKT inhibitors with non-PI3K/AKT controls with no restriction.

RESULTS:

The results were based on 34 studies from 34 published articles and 6 online registration trials (6710 patients). According to pairwise meta-analysis, PI3K/AKT inhibitors showed to be highly effective, especially for treating mutant cancers, but had poor safety profiles. According to our network meta-analysis, PI3K/AKT inhibitors, especially the AKT inhibitor capivasertib, are effective for treating solid cancers such as breast cancer (BC). Moreover, PI3K inhibitors, especially idelalisib, were effective for treating hematologic cancers such as chronic lymphocytic leukemia (CLL).

CONCLUSIONS:

The PI3K/AKT inhibitors are effective in patients with genetic mutations. For solid cancers such as BC, capivasertib was efficacy and safety. For hematological cancers represented by CLL, idelalisib was efficacy and safety. The above studies can be used when recommending appropriate targeted therapies for patients with different cancer types.

01 Nov 2024·NEOPLASIA

A highly selective PI3Kδ inhibitor BGB-10188 shows superior preclinical anti-tumor activities and decreased on-target side effects on colon

Article

Author: Wang, Fan ; Song, Xiaomin ; Yuan, Xi ; Yang, Xiaolong ; Ma, Zhilong ; Jiang, Beibei ; Guo, Mingming ; Su, Dan ; Wu, Yue ; Yang, Xiao ; Wang, Lai ; Li, Jing ; Lian, Zeqin ; Zhang, Taichang ; Bai, Huichen ; Liu, Ye ; Hu, Nan ; Wang, Jingyuan ; Wang, Zhiwei ; Liu, Xuesong ; Sun, Xuebing

PI3Kδ is a key signal transduction molecule in normal and malignant B cells, as well as in T-regulatory cells, making it a promising target for treatment of hematologic malignancies through both direct killing and anti-tumor immunity regulation. BGB-10188 is a highly selective inhibitor of PI3Kδ, showing more than 3000 folds selectivity over other PI3K isoforms and no significant inhibition across tested kinases. BGB-10188 potently inhibited PI3Kδ with IC₅₀s ranging from 1.7-16 nM through various in vitro assays and showed a long-lasting and strong target inhibition in mouse B cells in vivo. BGB-10188 showed significant antitumor effects in human B cell lymphoma xenograft models as single agent or in combination with the BTK inhibitor zanubrutinib. BGB-10188 showed significant Treg inhibition in blood but not in colon, along with less drug accumulation in colon compared with idelalisib, which is an approved PI3Kdelta inhibitor with high incidence of gastrointestinal side effects in clinic. In summary, BGB-10188 is a novel PI3Kδ inhibitor with high selectivity, potency and improved safety profile shown in preclinical studies, which is showing the potential as a best-in-class PI3Kδ inhibitor.

01 Oct 2024·Endocrinology Diabetes and Metabolism Case Reports

Hyperglycemia secondary to phosphatidylinositol-3 kinase (PI3K) inhibition

Article

Author: Greenfield, Jerry R ; Sriravindrarajah, Arunan ; Hurwitz, Joshua ; Lim, Elgene

Summary:

Phosphatidylinositol-3 kinase (PI3K) is a critical intracellular pathway that regulates cell growth, metabolism, and survival and has been implicated in most human cancers. Targeting this pathway has been approved as a therapeutic option for breast cancer and lymphoma (e.g. alpelisib, idelalisib), and there are several clinical trials underway in additional types of cancer. However, PI3K is an important mediator of the action of insulin, and the use of PI3K inhibitors has been associated with hyperglycemia. We report the case of a 53-year-old female with metastatic breast cancer who developed acute grade 3 hyperglycemia from a novel PI3K inhibitor, inavolisib. We review the treatment options for PI3K inhibitor-associated hyperglycemia. Treatment strategies that minimize hyperinsulinemia may be preferable considering animal models have demonstrated that hyperinsulinemia may result in partial reactivation of the PI3K pathway and counter the anti-cancer effectiveness of PI3K inhibitors.

Learning points:

Phosphatidylinositol-3 kinase (PI3K) is an intracellular pathway that regulates a range of physiological functions, including cell growth, metabolism, survival, and angiogenesis.Hyperactivation of the PI3K pathway is associated with almost all human cancers, and thus PI3K inhibition has been proposed as a treatment option for selected cancers.The action of insulin after binding to the insulin receptor on the cell surface (e.g. glucose uptake in skeletal muscle, inhibition of glycogenolysis and gluconeogenesis) is mediated by the intracellular PI3K pathway, and thus PI3K inhibition may lead to hyperinsulinemic hyperglycemia.All patients treated with PI3K inhibitors should receive pre-treatment screening for hyperglycemia, lifestyle advice, and a glucometer to measure fasting BGL and 2-h post-dinner BGL levels twice per week for at least the first 30 days of treatment.Insulin or insulin secretagogues (e.g. sulfonylurea) may inhibit the anti-tumor activity of PI3K inhibitors, and thus treatment of PI3K inhibitor-associated hyperglycemia should prefer alternative approaches such as a low carbohydrate diet, metformin, SGLT2i, or dose reduction of the PI3K inhibitor.

News (Medical) associated with Idelalisib

28 Oct 2024

·www.biospace.com

Evolving FDA Accelerated Approval Pathway Suffers Spate of Withdrawals

iStock/ Lynne Mitchell As therapies for rare and neurological diseases earn accelerated approval, experts laud the program’s intent while remaining concerned about confirmatory trials and clinical efficacy, especially as products greenlit under this pathway are pulled from the market. Last month, Pfizer’s sickle cell disease therapy Oxbryta , which won accelerated approval in 2019, was pulled from market due to risk of death and other complications, illustrating the risk of greenlighting therapeutics through this pathway. The FDA’s accelerated approval program has helped shepherd nearly 300 new drugs to the market, providing access to these medicines an average of 3.2 years earlier than with traditional approvals, according to the industry trade group PhRMA. Focusing on five drugs approved through this program, PhRMA’s report found that “millions of patients have gained faster access to clinical benefits, gaining additional life years, years of symptom control, or disease complication-free years over standard of care.” Having originated during the AIDS pandemic, many accelerated approvals have come in infectious disease, as well as in oncology, but the pathway has recently been leveraged by several high-pro and rare disease therapeutics. Over the past five years, the FDA has granted accelerated approval to novel therapies for Alzheimer’s disease, amyotrophic lateral sclerosis (ALS), Duchenne muscular dystrophy and more. While about half of drugs approved through this pathway, including Eisai and Biogen’s Alzheimer’s drug Leqembi and AbbVie’s ovarian cancer drug Elahere , have succeeded in securing traditional approval, Pfizer’s Oxbryta is but one example where the therapy was ultimately unsuccessful . Others include Biogen and Eisai’s first Alzheimer’s drug, Aduhelm, which Biogen discontinued in January 2024, and Takeda’s Exkivity, which was withdrawn from the lung cancer market in October 2023 after failing to meet the primary endpoint in a confirmatory study. “The advantage of an accelerated pathway is that the FDA can potentially move drugs to help people with terrible conditions forward quickly,” Joel Perlmutter, a professor of neurology at Washington University School of Medicine in St. Louis, told BioSpace . “The downside is how they do that.” Accelerated approval is granted on the basis of a surrogate endpoint—such as a biomarker of the disease—that is reasonably likely to predict clinical benefit. Companies are then required to conduct a confirmatory trial while the drug hits the market. Gene therapies for rare diseases would seem to be ideal candidates for accelerated approval, given that biomarkers feature prominently in these trials, Emil Kakkis, CEO of rare disease drug developer Ultragenyx, told BioSpace . Yet the accelerated approval pathway has so far been utilized for very few rare disease therapies. Kakkis noted just two: Sarepta Therapeutics’ Elevidys , approved in June 2023 for Duchenne muscular dystrophy (DMD), and bluebird bio’s Skysona , greenlit in September 2022 for cerebral adrenoleukodystrophy. Kakkis indicated he would like to see the pace pick up. In a 2011 study , he and a colleague estimated that better access to the accelerated approval pathway could greatly reduce development costs in the rare disease space, enabling development of three times as many rare disease drugs even if investment stayed flat. Moreover, Kakkis said, prioritizing primary disease activity biomarkers that measure the cause of the disease rather than clinical endpoints for approval is “a step forward in the evolution of drug development and our understanding of disease.” “We should start defining disease as the cause of disease, not the outcomes of disease,” he said. “And if we do that, we’ll actually treat disease better. We’ll treat it before it hurts you.” Accelerated Approval Evolves Beyond Infectious Disease and Oncology The accelerated approval program was implemented in 1992 in response to the HIV/AIDS epidemic. During the first 10 years of the program, 65% of drugs to receive accelerated approval were for infectious diseases. The next two decades saw a multitude of cancer drugs hit the market through this pathway—between 2012 and 2021, 83% of accelerated approvals were in oncology. Now, a third era, accelerated approvals for rare and neurological diseases, appears to be dawning. In June 2021, Biogen and Eisai’s Aduhelm won accelerated approval as the first disease-modifying treatment for Alzheimer’s disease. This was followed by BioMarin’s Voxzogo for achondroplasia in November 2021, Biogen’s Qalsody for a rare form of ALS in April 2023 and Elevidys in June 2023. The approvals of Aduhelm and Elevidys, in particular, set off a firestorm of controversy as experts questioned the clinical benefit of these products. The subsequent market withdrawal of Aduhelm and the confirmatory trial failure of Elevidys added fuel to the fire and sparked questions about the value of the accelerated approval program. Then came Oxbryta. Joseph Ross, a professor of medicine and public health at Yale School of Medicine, expressed concern that other FDA divisions do not appear to be heeding the hard-won learnings of the Oncology Center of Excellence. “We are essentially being forced to relearn the lessons that the Oncology Group learned over the past 25 years,” he told BioSpace . These lessons include the need to avoid confirmatory trial delays and focus on clinical outcomes, he said. The FDA did not respond to BioSpace ’s requests for comment. Better Understanding Biomarkers The accelerated approval pathway primarily relies on biomarkers that may predict subsequent clinical benefit, Perlmutter said. “Therein lies the whole issue.” Investigational medicines are traditionally considered based on their clinical benefit and risk profile, Perlmutter explained. “Using a biomarker to predict clinical benefit for both the benefit and the risk is nearly impossible.” Current biomarkers “will give an idea of target engagement,” Perlmutter said. “It rarely tells you whether it’s safe to do so, and that almost certainly requires clinical observation.” This is where the confirmatory trials come in. But these studies are often delayed. In 2022, NPR found that 42% of currently outstanding confirmatory studies either took more than a year to begin following an accelerated approval, or had not yet started. “Those follow-up studies are rarely done in a timely fashion,” Perlmutter noted. In the end, he added, drugs with “potentially harmful effects” and “without adequate benefits” can remain on the market. Oxbrtya was on the market for nearly five years, while Gilead Sciences’ Zydelig was available to patients with lymphoma for more than seven years before Gilead withdrew the drug in 2022 after failing to complete follow-up studies. Ross noted that the FDA does not require surrogate markers to be validated by clinical evidence of an association between the marker and clinical outcomes. “It seems like a fool’s errand to continue to allow products to be approved on the basis of the same fallible surrogate markers over and over,” he said. “I think we need a much better sense of the surrogate markers that are being used as efficacy endpoints.” Perlmutter offered Aduhelm, which won accelerated approval based on its ability to remove amyloid beta from the brains of patients with Alzheimer’s, as one example of a questionable biomarker. “The problem is, at that time—and actually currently—nobody [has] proved that reduction of amyloid in the brain predicts clinical benefit,” said Perlmutter, who served on the advisory committee that rejected Aduhelm and resigned as a result of its approval. But Kakkis contends that biomarkers are more of an issue when it comes to complex diseases like Alzheimer’s and ALS. “Those situations are trickier because you can’t be sure that the biomarker is reflecting the source of disease.” By contrast, biomarkers are a reliable surrogate endpoint in the rare, genetic disease space where they represent the underlying cause of the disease, he said. “In all cases, that’s transformed into clinical benefit down the road. It has not failed.” Perlmutter agreed that genetic diseases where the correlation between the biomarker and the cause of disease can be proven are an appropriate use of the accelerated approval pathway. “I just think you have to prove it before you approve it,” he said. A Worthy Regulatory Avenue There is a perception that accelerated approval is a regulatory shortcut , but Kakkis takes issue with the idea that it is “a less important or less rigorous approval.” “The biomarker-based approval of HIV drugs was not a compromise,” he said. “It’s far superior to doing it any other way.” He explained that it would have taken too long to run trials with clinical endpoints like opportunistic infections, hospitalizations or death with three or four combination drugs, “and too many people would have to get sick and die.” The FDA has taken steps to dispel this shortcut notion and tighten up the program. Responding to delays in the completion of confirmatory trials, legislation passed in 2022 empowers the agency to require these studies be underway before granting accelerated approval. But the experts who spoke with BioSpace say more changes are needed. Concerning confirmatory trials, Ross said, “I think we need much firmer deadlines that are much shorter in nature to ensure that we have timely evidence that helps the patient and clinician community quickly understand whether the drug is truly safe and effective.” Meanwhile, Perlmutter expressed concern about the potential for bias given that 65% of the FDA’s budget for human drugs comes from companies applying for approval. This is particularly an issue for accelerated approval “where judgment is critical and any potential bias can influence judgment,” he said. “Time is money for Big Pharma. Sooner approval means quicker onset of sales.”

Accelerated ApprovalDrug Approval

08 Aug 2024

·www.businesswire.com

Gilead Sciences Announces Second Quarter 2024 Financial Results

FOSTER CITY, Calif.--( BUSINESS WIRE )--Gilead Sciences, Inc. (Nasdaq: GILD) announced today its second quarter 2024 results of operations. “Gilead has had another strong quarter with 6% year-over-year growth in our base business. This was driven by sales of our therapies for HIV, Oncology and Liver Disease, including 8% growth for Biktarvy,” said Daniel O’Day, Gilead’s Chairman and Chief Executive Officer. “One of the key highlights of the quarter was interim data from the Phase 3 PURPOSE 1 trial showing 100% efficacy for lenacapavir in HIV prevention for cisgender women. We look forward to additional clinical readouts in the coming months, and to potentially launching seladelpar for primary biliary cholangitis in the United States.” Second Quarter 2024 Financial Results Total second quarter 2024 revenue increased 5% to $7.0 billion, compared to the same period in 2023, primarily due to higher product sales in HIV, Liver Disease and Oncology. Diluted earnings per share (“EPS”) was $1.29 in the second quarter 2024, compared to $0.83 in the same period in 2023. The increase was primarily driven by lower operating expenses, including a 2023 expense of $525 million for settlements with certain plaintiffs in HIV antitrust litigation which did not repeat in 2024, as well as higher revenues and lower income tax expense, partially offset by higher net unrealized losses on equity securities. Non-GAAP diluted EPS was $2.01 in the second quarter 2024, compared to $1.34 in the same period in 2023. The increase was primarily driven by lower operating expenses and higher revenues. As of June 30, 2024, Gilead had $2.8 billion of cash, cash equivalents and marketable debt securities, compared to $8.4 billion as of December 31, 2023. The decrease primarily reflects the $3.9 billion acquisition of CymaBay Therapeutics, Inc. and a $1.75 billion repayment of senior notes. During the second quarter 2024, Gilead generated $1.3 billion in operating cash flow, net of a $1.2 billion transition tax payment associated with the Tax Cuts and Jobs Act of 2017. During the second quarter 2024, Gilead paid dividends of $972 million and repurchased $100 million of common stock. Second Quarter 2024 Product Sales Total second quarter 2024 product sales increased 5% to $6.9 billion, compared to the same period in 2023. Total product sales, excluding Veklury, increased 6% to $6.7 billion in the second quarter 2024, compared to the same period in 2023, primarily due to higher product sales in HIV, Liver Disease and Oncology. HIV product sales increased 3% to $4.7 billion in the second quarter 2024, compared to the same period in 2023, primarily driven by higher demand across treatment and prevention, partially offset by lower average realized price due to channel mix. Biktarvy ® (bictegravir 50mg/emtricitabine 200mg (“FTC”)/tenofovir alafenamide 25mg (“TAF”)) sales increased 8% to $3.2 billion in the second quarter 2024, compared to the same period in 2023, primarily driven by higher demand. Descovy® (FTC 200mg/TAF 25mg) sales decreased 6% to $485 million in the second quarter 2024, compared to the same period in 2023, primarily driven by lower average realized price due to channel mix, partially offset by higher demand. The Liver Disease portfolio sales increased 17% to $832 million in the second quarter 2024, compared to the same period in 2023. This was primarily driven by higher average realized price due to channel mix in the United States, as well as higher demand in products for chronic hepatitis C virus (“HCV”), chronic hepatitis B virus (“HBV”) and, in Europe, chronic hepatitis D virus (“HDV”). Veklury sales decreased 16% to $214 million in the second quarter 2024, compared to the same period in 2023, primarily driven by lower rates of COVID-19 related hospitalizations. Cell Therapy product sales increased 11% to $521 million in the second quarter 2024, compared to the same period in 2023. Yescarta® (axicabtagene ciloleucel) sales increased 9% to $414 million in the second quarter 2024, compared to the same period in 2023, primarily driven by higher demand in relapsed or refractory (“R/R”) large B-cell lymphoma (“LBCL”) outside the United States. Tecartus® (brexucabtagene autoleucel) sales increased 21% to $107 million in the second quarter 2024, compared to the same period in 2023, driven by higher demand in R/R mantle cell lymphoma and R/R adult acute lymphoblastic leukemia (“ALL”). Trodelvy® (sacituzumab govitecan-hziy) sales increased 23% to $320 million in the second quarter 2024, compared to the same period in 2023, primarily driven by higher demand in second-line metastatic triple negative breast cancer and pre-treated HR+/HER2- metastatic breast cancer. Second Quarter 2024 Product Gross Margin, Operating Expenses and Effective Tax Rate Product gross margin was 77.7% in the second quarter 2024, compared to 78.0% in the same period in 2023. Non-GAAP product gross margin was 86.0% in the second quarter 2024, compared to 86.9% in the same period in 2023. Research & development (“R&D”) expenses were $1.4 billion in the second quarter 2024 and in the same period in 2023. Non-GAAP R&D expenses were $1.3 billion in the second quarter 2024, compared to $1.4 billion in the same period in 2023. The changes were primarily driven by timing of clinical activities, including wind-down of studies. Acquired IPR&D expenses were $38 million in the second quarter 2024. Selling, general and administrative (“SG&A”) expenses and non-GAAP SG&A expenses were $1.4 billion in the second quarter 2024, compared to $1.8 billion in the same period in 2023. The decreases in GAAP and non-GAAP SG&A expenses were primarily driven by the 2023 legal settlement expense referenced earlier which did not repeat in 2024. The effective tax rate (“ETR”) was 21.4% in the second quarter 2024, compared to 34.6% in the same period in 2023. The decrease in ETR primarily reflects a remeasurement of certain deferred tax liabilities in the prior year and a settlement with a tax authority in the second quarter 2024. Non-GAAP ETR was 17.8% in the second quarter 2024, compared to 21.0% in the same period in 2023. The decrease in non-GAAP ETR primarily reflects a settlement with a tax authority. Guidance and Outlook For the full-year 2024, Gilead expects: (in millions, except per share amounts) August 8, 2024 Guidance Low End High End Comparison to April 25, 2024 Guidance Product sales $ 27,100 $ 27,500 Unchanged Product sales, excluding Veklury $ 25,800 $ 26,200 Unchanged Veklury $ 1,300 $ 1,300 Unchanged Diluted EPS $ 0.00 $ 0.30 Previously $0.10 to $0.50 Non-GAAP diluted EPS $ 3.60 $ 3.90 Previously $3.45 to $3.85 Additional information and a reconciliation between GAAP and non-GAAP financial information for the 2024 guidance is provided in the accompanying tables. The financial guidance is subject to a number of risks and uncertainties. See the Forward-Looking Statements section below. Key Updates Since Our Last Quarterly Release Virology Presented data from the Phase 3 PURPOSE 1 trial evaluating twice-yearly subcutaneous lenacapavir for HIV prevention in cisgender women at the International AIDS Conference (“AIDS 2024”). At the interim analysis, lenacapavir demonstrated 100% efficacy with zero HIV infections and superiority to both background HIV incidence and once-daily oral Truvada® (FTC 200mg and tenofovir disoproxil fumarate 300mg (“TDF”)). Lenacapavir was generally well-tolerated and no new safety concerns were identified. The use of lenacapavir for PrEP is investigational. Highlighted long-term, five-year data for Biktarvy at AIDS 2024, demonstrating virologic suppression in Hispanic/Latine people with HIV, as well as older adults with comorbidities. Additionally, presented results from Gilead’s investigational treatment pipeline, including 48-week data from the Phase 2 portion of the Phase 2/3 ARTISTRY study of once-daily oral bictegravir plus lenacapavir, once-weekly oral agents GS-1720 and GS-4182, as well as twice-yearly lenacapavir in combination with two broadly neutralizing antibodies, teropavimab and zinlirvimab. Announced U.S. Food and Drug Administration (“FDA”) approval of an updated label for Biktarvy to include additional data for the treatment of pregnant adults with HIV-1 with suppressed viral loads. Presented Phase 2b MYR201 data demonstrating potential for the investigational combination of bulevirtide 10 mg with pegylated interferon alfa-2a as finite therapy for people with chronic HDV at the European Association for the Study of the Liver (“EASL”) meeting. These data were simultaneously published in the New England Journal of Medicine . Presented 144-week follow-up data from the Phase 3 MYR301 study at EASL that reinforced bulevirtide as an efficacious and generally well-tolerated long-term treatment option as monotherapy in adults with chronic HDV. Bulevirtide 2 mg remains the only approved treatment for HDV in the EU and is not approved in the U.S. Bulevirtide 10 mg is an investigational product and is not approved anywhere globally. Oncology Announced Trodelvy did not meet the primary endpoint of improvement in overall survival (“OS”) in the intention-to-treat (“ITT”) population of the confirmatory Phase 3 TROPiCS-04 study in locally advanced or metastatic urothelial cancer. A numerical improvement in OS favoring Trodelvy was observed, in addition to trends in improvement for select pre-specified non-alpha controlled subgroups analyses and secondary endpoints of progression-free survival and overall response rate. In the ITT population, there was a higher number of deaths due to adverse events with Trodelvy compared to single-agent chemotherapy, which were primarily observed early in treatment and related to neutropenic complications, including infection. Presented detailed results from the Phase 3 EVOKE-01 study evaluating Trodelvy in patients with metastatic or advanced non-small cell lung cancer (“NSCLC”) that had progressed on or after platinum-based chemotherapy and anti-PD(L)1 therapy at the American Society of Clinical Oncology (“ASCO”) meeting. These data were simultaneously published in the Journal of Clinical Oncology . As announced in January 2024, EVOKE-01 did not meet its primary endpoint of overall survival. The use of Trodelvy for lung cancer is investigational. Provided a longer-term update on Cohort A of the Phase 2 EVOKE-02 study of Trodelvy in combination with pembrolizumab in first-line advanced or metastatic squamous or non-squamous PD-L1-high NSCLC at the ASCO meeting. Announced new data from a pilot study in collaboration with Dana-Farber Cancer Institute that evaluated the safety of Yescarta in patients living with R/R primary or secondary central nervous system lymphoma, an investigational use. This data was presented at the ASCO meeting. Presented updated, four-year OS data from the pivotal Phase 2 ZUMA-3 study evaluating Tecartus in adult patients with R/R B-cell ALL at the ASCO meeting. Presented updated analysis at the ASCO meeting from Arm A1 of the Phase 2 EDGE-Gastric study evaluating domvanalimab, zimberelimab (“zim”) and FOLFOX as a potential first-line treatment for upper gastrointestinal cancers, in partnership with Arcus Biosciences, Inc. (“Arcus”). Additionally, presented Phase 1b/2 ARC-9 Cohort B data with our partner Arcus, which is evaluating etrumadenant plus zim, FOLFOX and bevacizumab in third-line metastatic colorectal cancer. These products and uses are investigational. Announced preliminary findings at the European Hematology Association (“EHA”) meeting from the Phase 2 ZUMA-24 study suggesting outpatient administration of Yescarta is feasible. Additionally, presented real-world manufacturing experience analysis demonstrating a statistically significant higher number of R/R large B-cell lymphoma patients that received second-line treatment with Yescarta achieved first-pass manufacturing success compared to patients that received treatment with Yescarta in third-line and beyond. Announced key operational updates, together with Arcellx, Inc. (“Arcellx”), for the anitocabtagene autoleucel multiple myeloma development program, including the design of the Phase 3 iMMagine-3 trial as a second- to fourth-line treatment for multiple myeloma, as well as the completion of the technical transfer to Kite. Inflammation Presented two-year interim results from the ongoing long-term Phase 3 ASSURE study evaluating seladelpar in people living with primary biliary cholangitis (“PBC”) who participated in any prior seladelpar clinical study at the Digestive Diseases Week and EASL meetings. The data demonstrated a sustained and consistent long-term efficacy and safety profile for seladelpar in PBC. Seladelpar is an investigational product and is currently under review by FDA, with a PDUFA date of August 14, 2024. Entered into an amended license agreement featuring the buy-out of global seladelpar royalties from Janssen Pharmaceutica NV for $320 million. This transaction will be reflected in Gilead’s third quarter results. Corporate Announced Gilead reached a settlement agreement in principle in the federal TDF litigation in the U.S. District Court for the Northern District of California. The agreement, which is subject to certain conditions, provides that Gilead will make a one-time payment of up to $40 million and is expected to resolve the claims of the overwhelming majority of plaintiffs in the federal TDF litigation. Announced Chief Medical Officer Merdad Parsey, MD, PhD, will leave the company in the first quarter of 2025. A search is underway for his successor. The Board declared a quarterly dividend of $0.77 per share of common stock for the third quarter of 2024. The dividend is payable on September 27, 2024, to stock holders of record at the close of business on September 13, 2024. Future dividends will be subject to Board approval. Certain amounts and percentages in this press release may not sum or recalculate due to rounding. Conference Call At 1:30 p.m. Pacific Time today, Gilead will host a conference call to discuss Gilead’s results. A live webcast will be available on http://investors.gilead.com and will be archived on www.gilead.com for one year. Non-GAAP Financial Information The information presented in this document has been prepared in accordance with U.S. generally accepted accounting principles (“GAAP”), unless otherwise noted as non-GAAP. Management believes non-GAAP information is useful for investors, when considered in conjunction with Gilead’s GAAP financial information, because management uses such information internally for its operating, budgeting and financial planning purposes. Non-GAAP information is not prepared under a comprehensive set of accounting rules and should only be used to supplement an understanding of Gilead’s operating results as reported under GAAP. Non-GAAP financial information generally excludes acquisition-related expenses including amortization of acquired intangible assets and other items that are considered unusual or not representative of underlying trends of Gilead’s business, fair value adjustments of equity securities and discrete and related tax charges or benefits associated with changes in tax related laws and guidelines. Although Gilead consistently excludes the amortization of acquired intangible assets from the non-GAAP financial information, management believes that it is important for investors to understand that such intangible assets were recorded as part of acquisitions and contribute to ongoing revenue generation. Non-GAAP measures may be defined and calculated differently by other companies in the same industry. Reconciliations of the non-GAAP financial measures to the most directly comparable GAAP financial measures are provided in the accompanying tables. About Gilead Sciences Gilead Sciences, Inc. is a biopharmaceutical company that has pursued and achieved breakthroughs in medicine for more than three decades, with the goal of creating a healthier world for all people. The company is committed to advancing innovative medicines to prevent and treat life-threatening diseases, including HIV, viral hepatitis, COVID-19 and cancer. Gilead operates in more than 35 countries worldwide, with headquarters in Foster City, California. Forward-Looking Statements Statements included in this press release that are not historical in nature are forward-looking statements within the meaning of the Private Securities Litigation Reform Act of 1995. Gilead cautions readers that forward-looking statements are subject to certain risks and uncertainties that could cause actual results to differ materially. These risks and uncertainties include those relating to: Gilead’s ability to achieve its anticipated full year 2024 financial results, including as a result of the uncertainty of the amount and timing of Veklury revenues; Gilead’s ability to make progress on any of its long-term ambitions or priorities laid out in its corporate strategy; Gilead’s ability to accelerate or sustain revenues for its virology, oncology and other programs; Gilead’s ability to realize the potential benefits of acquisitions, collaborations or licensing arrangements, including the arrangements with Arcellx and Arcus; patent protection and estimated loss of exclusivity for our products and product candidates; Gilead’s ability to initiate, progress or complete clinical trials within currently anticipated timeframes or at all, the possibility of unfavorable results from ongoing and additional clinical trials, including those involving Biktarvy, Trodelvy, Truvada, Yescarta, bevacizumab, bictegravir, bulevirtide, anitocabtagene autoleucel, domvanalimab, etrumadenant, GS-1720, GS-4182, lenacapavir, teropavimab, seladelpar, zimberelimab, and zinlirvimab (such as the ARTISTRY-1, ASSURE, EDGE-Gastric, EVOKE-01, EVOKE-02, iMMagine-3, MYR201, MYR301, PURPOSE-1, TROPiCS-04, ZUMA-3 and ZUMA-24 studies) , and the risk that safety and efficacy data from clinical trials may not warrant further development of Gilead’s product candidates or the product candidates of Gilead’s strategic partners; Gilead’s ability to submit new drug applications for new product candidates or expanded indications in the currently anticipated timelines; Gilead’s ability to receive or maintain regulatory approvals in a timely manner or at all, including FDA approval of the New Drug Application for seladelpar, and the risk that any such approvals, if granted, may be subject to significant limitations on use and may be subject to withdrawal or other adverse actions by the applicable regulatory authority (such as the risk that the FDA may not grant full approval or may withdraw its accelerated approval for Trodelvy for the treatment of locally advanced or metastatic urothelial cancer); Gilead’s ability to successfully commercialize its products; the risk of potential disruptions to the manufacturing and supply chain of Gilead’s products; pricing and reimbursement pressures from government agencies and other third parties, including required rebates and other discounts; a larger than anticipated shift in payer mix to more highly discounted payer segments; market share and price erosion caused by the introduction of generic versions of Gilead products; the risk that physicians and patients may not see advantages of Gilead’s products over other therapies and may therefore be reluctant to prescribe the products, including Biktarvy; and other risks identified from time to time in Gilead’s reports filed with the SEC, including annual reports on Form 10-K, quarterly reports on Form 10-Q and current reports on Form 8-K. In addition, Gilead makes estimates and judgments that affect the reported amounts of assets, liabilities, revenues and expenses and related disclosures. Gilead bases its estimates on historical experience and on various other market specific and other relevant assumptions that it believes to be reasonable under the circumstances, the results of which form the basis for making judgments about the carrying values of assets and liabilities that are not readily apparent from other sources. There may be other factors of which Gilead is not currently aware that may affect matters discussed in the forward-looking statements and may also cause actual results to differ significantly from these estimates. Further, results for the quarter ended June 30, 2024 are not necessarily indicative of operating results for any future periods. Gilead directs readers to its press releases, annual reports on Form 10-K, quarterly reports on Form 10-Q and other subsequent disclosure documents filed with the SEC. Gilead claims the protection of the Safe Harbor contained in the Private Securities Litigation Reform Act of 1995 for forward-looking statements. The reader is cautioned that forward-looking statements are not guarantees of future performance and is cautioned not to place undue reliance on these forward-looking statements. All forward-looking statements are based on information currently available to Gilead and Gilead assumes no obligation to update or supplement any such forward-looking statements other than as required by law. Any forward-looking statements speak only as of the date hereof or as of the dates indicated in the statements. Gilead owns or has rights to various trademarks, copyrights and trade names used in its business, including the following: GILEAD®, GILEAD SCIENCES®, KITE TM , AMBISOME®, ATRIPLA®, BIKTARVY®, CAYSTON®, COMPLERA®, DESCOVY®, DESCOVY FOR PREP®, EMTRIVA®, EPCLUSA®, EVIPLERA®, GENVOYA®, HARVONI®, HEPCLUDEX®, HEPSERA®, JYSELECA®, LETAIRIS®, ODEFSEY®, SOVALDI®, STRIBILD®, SUNLENCA® , TECARTUS®, TRODELVY®, TRUVADA®, TRUVADA FOR PREP®, TYBOST®, VEKLURY®, VEMLIDY®, VIREAD®, VOSEVI®, YESCARTA® and ZYDELIG®. KEYTRUDA® is a registered trademark of Merck Sharp & Dohme LLC, a subsidiary of Merck & Co., Inc., Rahway, NJ, United States. Other trademarks are the property of their respective owners. For more information on Gilead Sciences, Inc., please visit www.gilead.com or call the Gilead Public Affairs Department at 1-800-GILEAD-5 (1-800-445-3235). GILEAD SCIENCES, INC. CONDENSED CONSOLIDATED STATEMENTS OF OPERATIONS (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except per share amounts) 2024 2023 2024 2023 Revenues: Product sales $ 6,912 $ 6,564 $ 13,559 $ 12,870 Royalty, contract and other revenues 41 35 81 81 Total revenues 6,954 6,599 13,640 12,951 Costs and expenses: Cost of goods sold 1,544 1,442 3,096 2,843 Research and development expenses 1,351 1,407 2,871 2,854 Acquired in-process research and development expenses 38 236 4,169 717 In-process research and development impairment — — 2,430 — Selling, general and administrative expenses 1,377 1,849 2,752 3,168 Total costs and expenses 4,309 4,934 15,317 9,581 Operating income (loss) 2,644 1,665 (1,678 ) 3,370 Interest expense 237 230 491 459 Other (income) expense, net 355 (152 ) 265 22 Income (loss) before income taxes 2,053 1,588 (2,433 ) 2,888 Income tax expense 438 549 123 865 Net income (loss) 1,614 1,039 (2,556 ) 2,024 Net loss attributable to noncontrolling interest — (6 ) — (32 ) Net income (loss) attributable to Gilead $ 1,614 $ 1,045 $ (2,556 ) $ 2,055 Basic earnings (loss) per share attributable to Gilead $ 1.29 $ 0.84 $ (2.05 ) $ 1.65 Shares used in basic earnings (loss) per share attributable to Gilead calculation 1,247 1,249 1,247 1,249 Diluted earnings (loss) per share attributable to Gilead $ 1.29 $ 0.83 $ (2.05 ) $ 1.63 Shares used in diluted earnings (loss) per share attributable to Gilead calculation 1,251 1,258 1,247 1,260 Supplemental Information: Cash dividends declared per share $ 0.77 $ 0.75 $ 1.54 $ 1.50 Product gross margin 77.7 % 78.0 % 77.2 % 77.9 % Research and development expenses as a % of revenues 19.4 % 21.3 % 21.0 % 22.0 % Selling, general and administrative expenses as a % of revenues 19.8 % 28.0 % 20.2 % 24.5 % Operating margin 38.0 % 25.2 % (12.3 )% 26.0 % Effective tax rate 21.4 % 34.6 % (5.1 )% 29.9 % GILEAD SCIENCES, INC. TOTAL REVENUE SUMMARY (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages) 2024 2023 Change 2024 2023 Change Product sales: HIV $ 4,745 $ 4,626 3 % $ 9,088 $ 8,816 3 % Liver Disease 832 711 17 % 1,569 1,386 13 % Oncology 841 728 15 % 1,629 1,398 17 % Other 280 243 15 % 504 442 14 % Total product sales excluding Veklury 6,698 6,308 6 % 12,790 12,041 6 % Veklury 214 256 (16 )% 769 829 (7 )% Total product sales 6,912 6,564 5 % 13,559 12,870 5 % Royalty, contract and other revenues 41 35 18 % 81 81 (1 )% Total revenues $ 6,954 $ 6,599 5 % $ 13,640 $ 12,951 5 % GILEAD SCIENCES, INC. NON-GAAP FINANCIAL INFORMATION (1) (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages) 2024 2023 Change 2024 2023 Change Non-GAAP: Cost of goods sold $ 965 $ 861 12% $ 1,939 $ 1,732 12% Research and development expenses $ 1,335 $ 1,377 (3)% $ 2,738 $ 2,816 (3)% Acquired IPR&D expenses (2) $ 38 $ 236 (84)% $ 4,169 $ 717 NM Selling, general and administrative expenses $ 1,351 $ 1,848 (27)% $ 2,646 $ 3,166 (16)% Other (income) expense, net $ (37 ) $ (83 ) (56)% $ (141 ) $ (165 ) (15)% Diluted earnings per share attributable to Gilead $ 2.01 $ 1.34 50% $ 0.70 $ 2.71 (74)% Shares used in non-GAAP diluted earnings per share attributable to Gilead calculation 1,251 1,258 (1)% 1,254 1,260 —% Product gross margin 86.0 % 86.9 % -84 bps 85.7 % 86.5 % -84 bps Research and development expenses as a % of revenues 19.2 % 20.9 % -167 bps 20.1 % 21.7 % -167 bps Selling, general and administrative expenses as a % of revenues 19.4 % 28.0 % -857 bps 19.4 % 24.4 % -504 bps Operating margin 47.0 % 34.5 % NM 15.7 % 34.9 % NM Effective tax rate 17.8 % 21.0 % -322 bps 51.4 % 20.0 % NM ________________________________ NM - Not Meaningful (1) Refer to Non-GAAP Financial Information section above for further disclosures on non-GAAP financial measures. A reconciliation between GAAP and non-GAAP financial information is provided in the tables below. (2) Equal to GAAP financial information. GILEAD SCIENCES, INC. RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages and per share amounts) 2024 2023 2024 2023 Cost of goods sold reconciliation: GAAP cost of goods sold $ 1,544 $ 1,442 $ 3,096 $ 2,843 Acquisition-related – amortization (1) (579 ) (581 ) (1,158 ) (1,110 ) Restructuring — — 1 — Non-GAAP cost of goods sold $ 965 $ 861 $ 1,939 $ 1,732 Product gross margin reconciliation: GAAP product gross margin 77.7 % 78.0 % 77.2 % 77.9 % Acquisition-related – amortization (1) 8.4 % 8.8 % 8.5 % 8.6 % Restructuring (— )% — % (— )% — % Non-GAAP product gross margin 86.0 % 86.9 % 85.7 % 86.5 % Research and development expenses reconciliation: GAAP research and development expenses $ 1,351 $ 1,407 $ 2,871 $ 2,854 Acquisition-related – other costs (2) (3 ) (30 ) (70 ) (38 ) Restructuring (13 ) — (63 ) — Non-GAAP research and development expenses $ 1,335 $ 1,377 $ 2,738 $ 2,816 IPR&D impairment reconciliation: GAAP IPR&D impairment $ — $ — $ 2,430 $ — IPR&D impairment — — (2,430 ) — Non-GAAP IPR&D impairment $ — $ — $ — $ — Selling, general and administrative expenses reconciliation: GAAP selling, general and administrative expenses $ 1,377 $ 1,849 $ 2,752 $ 3,168 Acquisition-related – other costs (2) (17 ) (1 ) (84 ) (2 ) Restructuring (8 ) — (22 ) — Non-GAAP selling, general and administrative expenses $ 1,351 $ 1,848 $ 2,646 $ 3,166 Operating income (loss) reconciliation: GAAP operating income (loss) $ 2,644 $ 1,665 $ (1,678 ) $ 3,370 Acquisition-related – amortization (1) 579 581 1,158 1,110 Acquisition-related – other costs (2) 21 31 153 40 Restructuring 21 — 84 — IPR&D impairment — — 2,430 — Non-GAAP operating income $ 3,265 $ 2,277 $ 2,148 $ 4,521 Operating margin reconciliation: GAAP operating margin 38.0 % 25.2 % (12.3 )% 26.0 % Acquisition-related – amortization (1) 8.3 % 8.8 % 8.5 % 8.6 % Acquisition-related – other costs (2) 0.3 % 0.5 % 1.1 % 0.3 % Restructuring 0.3 % — % 0.6 % — % IPR&D impairment — % — % 17.8 % — % Non-GAAP operating margin 47.0 % 34.5 % 15.7 % 34.9 % Other (income) expense, net reconciliation: GAAP other (income) expense, net $ 355 $ (152 ) $ 265 $ 22 (Loss) gain from equity securities, net (392 ) 69 (405 ) (187 ) Non-GAAP other (income) expense, net $ (37 ) $ (83 ) $ (141 ) $ (165 ) Income (loss) before income taxes reconciliation: GAAP income (loss) before income taxes $ 2,053 $ 1,588 $ (2,433 ) $ 2,888 Acquisition-related – amortization (1) 579 581 1,158 1,110 Acquisition-related – other costs (2) 21 31 153 40 Restructuring 21 — 84 — IPR&D impairment — — 2,430 — Loss (gain) from equity securities, net 392 (69 ) 405 187 Non-GAAP income before income taxes $ 3,065 $ 2,131 $ 1,798 $ 4,226 GILEAD SCIENCES, INC. RECONCILIATION OF GAAP TO NON-GAAP FINANCIAL INFORMATION - (Continued) (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions, except percentages and per share amounts) 2024 2023 2024 2023 Income tax expense reconciliation: GAAP income tax expense $ 438 $ 549 $ 123 $ 865 Income tax effect of non-GAAP adjustments: Acquisition-related – amortization (1) 121 120 242 227 Acquisition-related – other costs (2) 7 5 37 8 Restructuring 7 — 16 — IPR&D impairment — — 611 — Loss (gain) from equity securities, net 33 1 (6 ) 1 Discrete and related tax charges (3) (60 ) (227 ) (100 ) (256 ) Non-GAAP income tax expense $ 546 $ 448 $ 923 $ 844 Effective tax rate reconciliation: GAAP effective tax rate 21.4 % 34.6 % (5.1 )% 29.9 % Income tax effect of above non-GAAP adjustments and discrete and related tax adjustments (3) (3.5 )% (13.5 )% 56.4 % (10.0 )% Non-GAAP effective tax rate 17.8 % 21.0 % 51.4 % 20.0 % Net income (loss) attributable to Gilead reconciliation: GAAP net income (loss) attributable to Gilead $ 1,614 $ 1,045 $ (2,556 ) $ 2,055 Acquisition-related – amortization (1) 458 461 916 884 Acquisition-related – other costs (2) 14 26 117 32 Restructuring 14 — 68 — IPR&D impairment — — 1,819 — Loss (gain) from equity securities, net 359 (70 ) 412 187 Discrete and related tax charges (3) 60 227 100 256 Non-GAAP net income attributable to Gilead $ 2,519 $ 1,688 $ 874 $ 3,414 Diluted earnings (loss) per share reconciliation: GAAP diluted earnings (loss) per share $ 1.29 $ 0.83 $ (2.05 ) $ 1.63 Acquisition-related – amortization (1) 0.37 0.37 0.73 0.70 Acquisition-related – other costs (2) 0.01 0.02 0.09 0.03 Restructuring 0.01 — 0.05 — IPR&D impairment — — 1.46 — Loss (gain) from equity securities, net 0.29 (0.06 ) 0.33 0.15 Discrete and related tax charges (3) 0.05 0.18 0.08 0.20 Non-GAAP diluted earnings per share $ 2.01 $ 1.34 $ 0.70 $ 2.71 Non-GAAP adjustment summary: Cost of goods sold adjustments $ 579 $ 581 $ 1,157 $ 1,110 Research and development expenses adjustments 16 30 133 38 IPR&D impairment adjustments — — 2,430 — Selling, general and administrative expenses adjustments 26 1 106 2 Total non-GAAP adjustments to costs and expenses 620 612 3,826 1,150 Other (income) expense, net adjustments 392 (69 ) 405 187 Total non-GAAP adjustments before income taxes 1,012 543 4,231 1,338 Income tax effect of non-GAAP adjustments above (168 ) (126 ) (900 ) (235 ) Discrete and related tax charges (3) 60 227 100 256 Total non-GAAP adjustments to net income attributable to Gilead $ 905 $ 644 $ 3,431 $ 1,358 ______________________________ (1) Relates to amortization of acquired intangibles. (2) Adjustments include integration expenses, contingent consideration fair value adjustments and other expenses associated with Gilead’s acquisitions of MYR GmbH, MiroBio, Ltd., Tmunity Therapeutics, Inc., XinThera, Inc. and CymaBay Therapeutics, Inc. (3) Represents discrete and related deferred tax charges or benefits primarily associated with acquired intangible assets and transfers of intangible assets from a foreign subsidiary to Ireland and the United States. GILEAD SCIENCES, INC. RECONCILIATION OF GAAP TO NON-GAAP 2024 FULL-YEAR GUIDANCE (1) (unaudited) (in millions, except percentages and per share amounts) Provided February 6, 2024 Updated April 25, 2024 Updated August 8, 2024 Projected product gross margin GAAP to non-GAAP reconciliation: GAAP projected product gross margin 76.0% - 77.0% 76.0% - 77.0% 76.0% - 77.0% Acquisition-related expenses and restructuring expenses ~ 9.0% ~ 9.0% ~ 9.0% Non-GAAP projected product gross margin 85.0% - 86.0% 85.0% - 86.0% 85.0% - 86.0% Projected operating income GAAP to non-GAAP reconciliation: GAAP projected operating income $8,700 - $9,200 $1,900 - $2,400 $2,100 - $2,500 IPR&D impairment, acquisition-related and restructuring expenses ~ 2,500 ~ 5,100 ~ 5,100 Non-GAAP projected operating income $11,200 - $11,700 $7,000 - $7,500 $7,200 - $7,600 Projected effective tax rate GAAP to non-GAAP reconciliation: GAAP projected effective tax rate ~ 21% ~ 65% ~ 87% Income tax effect of above non-GAAP adjustments and fair value adjustments of equity securities, and discrete and related tax adjustments (~ 2%) (~ 35%) (~ 57%) Non-GAAP projected effective tax rate ~ 19% ~ 30% ~ 30% Projected diluted EPS GAAP to non-GAAP reconciliation: GAAP projected diluted EPS $5.15 - $5.55 $0.10 - $0.50 $0.00 - $0.30 IPR&D impairment, acquisition-related and restructuring expenses, fair value adjustments of equity securities and discrete and related tax adjustments ~ 1.70 ~ 3.35 ~ 3.60 Non-GAAP projected diluted EPS $6.85 - $7.25 $3.45 - $3.85 $3.60 - $3.90 ________________________________ (1) Our full-year guidance excludes the potential impact of any (i) acquisitions or business development transactions that have not been executed, (ii) future fair value adjustments of equity securities and (iii) discrete tax charges or benefits associated with changes in tax related laws and guidelines that have not been enacted, as Gilead is unable to project such amounts. The non-GAAP full-year guidance includes non-GAAP adjustments to actual current period results as well as adjustments for the known future impact associated with events that have already occurred, such as future amortization of our intangible assets and the future impact of discrete and related deferred tax charges or benefits primarily associated with acquired intangible assets and transfers of intangible assets from a foreign subsidiary to Ireland and the United States. GILEAD SCIENCES, INC. CONDENSED CONSOLIDATED BALANCE SHEETS (unaudited) June 30, December 31, (in millions) 2024 2023 Assets Cash, cash equivalents and marketable debt securities $ 2,772 $ 8,428 Accounts receivable, net 4,663 4,660 Inventories 3,388 3,366 Property, plant and equipment, net 5,346 5,317 Intangible assets, net 22,832 26,454 Goodwill 8,314 8,314 Other assets 6,265 5,586 Total assets $ 53,579 $ 62,125 Liabilities and Stockholders’ Equity Current liabilities $ 10,781 $ 11,280 Long-term liabilities 24,602 28,096 Stockholders’ equity (1) 18,197 22,749 Total liabilities and stockholders’ equity $ 53,579 $ 62,125 ________________________________ (1) As of June 30, 2024 and December 31, 2023, there were 1,246 shares of common stock issued and outstanding. GILEAD SCIENCES, INC. SELECTED CASH FLOW INFORMATION (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions) 2024 2023 2024 2023 Net cash provided by operating activities $ 1,325 $ 2,337 $ 3,544 $ 4,082 Net cash used in investing activities (307 ) (483 ) (2,514 ) (1,309 ) Net cash used in financing activities (2,953 ) (1,101 ) (4,314 ) (2,507 ) Effect of exchange rate changes on cash and cash equivalents (11 ) 14 (29 ) 26 Net change in cash and cash equivalents (1,947 ) 768 (3,313 ) 292 Cash and cash equivalents at beginning of period 4,718 4,936 6,085 5,412 Cash and cash equivalents at end of period $ 2,772 $ 5,704 $ 2,772 $ 5,704 Three Months Ended Six Months Ended June 30, June 30, (in millions) 2024 2023 2024 2023 Net cash provided by operating activities $ 1,325 $ 2,337 $ 3,544 $ 4,082 Capital expenditures (130 ) (139 ) (235 ) (248 ) Free cash flow (1) $ 1,195 $ 2,199 $ 3,309 $ 3,834 ________________________________ (1) Free cash flow is a non-GAAP liquidity measure. Please refer to our disclosures in the Non-GAAP Financial Information section above. GILEAD SCIENCES, INC. PRODUCT SALES SUMMARY (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions) 2024 2023 2024 2023 HIV Biktarvy – U.S. $ 2,585 $ 2,439 $ 4,900 $ 4,600 Biktarvy – Europe 370 302 735 606 Biktarvy – Rest of World 277 237 542 449 3,232 2,979 6,177 5,656 Descovy – U.S. 434 460 805 855 Descovy – Europe 25 25 51 50 Descovy – Rest of World 26 31 55 60 485 516 911 965 Genvoya – U.S. 372 455 704 872 Genvoya – Europe 45 56 95 111 Genvoya – Rest of World 23 29 44 58 440 540 843 1,041 Odefsey – U.S. 233 267 457 497 Odefsey – Europe 72 74 148 149 Odefsey – Rest of World 10 11 21 22 315 351 626 668 Symtuza - Revenue share (1) – U.S. 131 84 236 182 Symtuza - Revenue share (1) – Europe 34 33 67 70 Symtuza - Revenue share (1) – Rest of World 3 3 6 7 168 120 309 259 Other HIV (2) – U.S. 65 74 125 136 Other HIV (2) – Europe 25 31 70 63 Other HIV (2) – Rest of World 15 15 27 28 105 120 222 228 Total HIV – U.S. 3,821 3,778 7,226 7,142 Total HIV – Europe 571 521 1,167 1,049 Total HIV – Rest of World 353 326 695 624 4,745 4,626 9,088 8,816 Liver Disease Sofosbuvir / Velpatasvir (3) – U.S. 267 223 515 427 Sofosbuvir / Velpatasvir (3) – Europe 84 84 163 174 Sofosbuvir / Velpatasvir (3) – Rest of World 126 90 203 181 476 397 881 782 Vemlidy – U.S. 117 96 212 183 Vemlidy – Europe 11 10 22 19 Vemlidy – Rest of World 115 113 233 216 243 219 467 418 Other Liver Disease (4) – U.S. 47 37 89 64 Other Liver Disease (4) – Europe 47 37 94 78 Other Liver Disease (4) – Rest of World 19 21 38 44 113 95 221 186 Total Liver Disease – U.S. 431 356 816 674 Total Liver Disease – Europe 142 131 279 271 Total Liver Disease – Rest of World 259 225 474 441 832 711 1,569 1,386 Veklury Veklury – U.S. 76 97 391 349 Veklury – Europe 53 52 123 163 Veklury – Rest of World 85 107 255 317 214 256 769 829 GILEAD SCIENCES, INC. PRODUCT SALES SUMMARY - (Continued) (unaudited) Three Months Ended Six Months Ended June 30, June 30, (in millions) 2024 2023 2024 2023 Oncology Cell Therapy Tecartus – U.S. 63 56 118 114 Tecartus – Europe 37 29 73 56 Tecartus – Rest of World 7 4 16 6 107 88 207 177 Yescarta – U.S. 186 217 357 427 Yescarta – Europe 169 133 327 254 Yescarta – Rest of World 58 30 110 58 414 380 794 739 Total Cell Therapy – U.S. 250 272 475 542 Total Cell Therapy – Europe 206 162 400 310 Total Cell Therapy – Rest of World 66 34 126 65 521 469 1,001 916 Trodelvy Trodelvy – U.S. 224 189 429 351 Trodelvy – Europe 69 53 137 107 Trodelvy – Rest of World 26 17 62 23 320 260 628 482 Total Oncology – U.S. 474 462 904 893 Total Oncology – Europe 275 215 537 417 Total Oncology – Rest of World 92 51 188 88 841 728 1,629 1,398 Other AmBisome – U.S. 17 20 31 27 AmBisome – Europe 69 69 139 129 AmBisome – Rest of World 65 61 124 111 151 151 294 267 Other (5) – U.S. 98 64 156 127 Other (5) – Europe 8 10 18 22 Other (5) – Rest of World 24 17 36 26 130 92 209 175 Total Other – U.S. 115 85 188 153 Total Other – Europe 77 80 156 152 Total Other – Rest of World 88 78 160 137 280 243 504 442 Total product sales – U.S. 4,916 4,777 9,525 9,211 Total product sales – Europe 1,118 999 2,262 2,052 Total product sales – Rest of World 878 788 1,772 1,607 $ 6,912 $ 6,564 $ 13,559 $ 12,870 ______________________________ (1) Represents Gilead’s revenue from cobicistat (“C”), FTC and TAF in Symtuza (darunavir/C/FTC/TAF), a fixed dose combination product commercialized by Janssen Sciences Ireland Unlimited Company. (2) Includes Atripla, Complera/Eviplera, Emtriva, Sunlenca, Stribild, Truvada and Tybost. (3) Includes Epclusa and the authorized generic version of Epclusa sold by Gilead’s separate subsidiary, Asegua Therapeutics LLC (“Asegua”). (4) Includes ledipasvir/sofosbuvir (Harvoni and the authorized generic version of Harvoni sold by Asegua), Hepcludex, Hepsera, Sovaldi, Viread and Vosevi. (5) Includes Cayston, Jyseleca, Letairis, Ranexa and Zydelig.

Clinical ResultPhase 3Financial StatementPhase 2License out/in

08 Aug 2024

·www.echemi.com

Regulatory Challenges of Gene Therapy and Cancer Drugs: Industry Trends Behind the Withdrawal of Zydelig and FDA's Response

In 2022, Gilead announced that it would voluntarily withdraw Zydelig from the U.S. market for two lymphoma treatments, a full six years after it suspended the trial due to patient deaths. A Gilead spokesperson clarified that the withdrawal was not due to safety concerns, but rather because of insurmountable obstacles to recruiting subjects for additional research trials required by the FDA. Nevertheless, Zydelig retains its eligibility for the treatment of chronic lymphocytic leukemia and remains on the market for patients. Notably, the withdrawal of Zydelig coincides with the withdrawal of several other PI3K inhibitors used to treat follicular lymphoma: Secura Bio's duvelisib (trade name Copiktra) withdrawn in December 2021, TG's umbralisib (trade name Ukoniq) withdrawn in 2022 (here may be a clerical error, read "February" or adjusted to another month), Bayer's copanlisib (trade name Aliqopa) also withdrew from the market in November 2023. Together, these events outline an industry trend. A study published in JAMA Internal Medicine reveals an interesting data point: Before Gilead decided to withdraw some uses of Zydelig from the U.S. market, its global sales had reached a staggering $842 million. This reflects the wide application and high recognition of the drug in the market, although it ultimately failed to fully meet all expectations for various reasons. Interestingly, the pharmaceutical industry sometimes employs a series of ingenious strategies to speed up the process of bringing a product to market. Eli Lilly, for example, successfully used all four avenues of acceleration to bring oncology product Lartruvo to market in 2016. The key clinical data for the product is based only on the results of a trial involving 133 patients, and while the results showed a possible positive impact on survival outcomes for sarcoma, a cancer that affects muscles and other soft tissues, the specific effect on slowing cancer growth is unclear. However, just over two years later, a larger study revealed that Lartruvo had no significant impact on patient survival, and Eli Lilly had to withdraw it from the market. Despite this, Lartruvo still managed to achieve a whopping $500 million in sales during its short market life. Among the many drugs approved for accelerated marketing, oncology products have become the hardest hit by ineffective drugs. However, as the development of therapies continues to deepen and progress, new questions continue to emerge and are presented to the FDA. In particular, advanced therapies represented by cell and gene therapies, when they meet with the accelerated approval system, have brought unprecedented challenges to this "old revolution". Given the complexity of cell and gene therapies and the relative lack of understanding of their safety, once ineffective advanced therapies are released to the market, the consequences and impacts will be far beyond the scope of small molecule ineffective drugs. For example, the tragic death of a three-year-old boy in a clinical trial of Pfizer's fordadistrogene movaparvovec, a gene therapy for Duchenne muscular dystrophy, highlights the shortcomings and limitations of researchers in predicting the potential for serious adverse events. As vectors of ssRNA (single stranded RNA), viruses (such as AAV) play a critical role in gene therapy, but can also cause a series of serious adverse events including cardiopulmonary failure, myocarditis, thrombotic microangiopathy, and acute liver failure. These potential risks have forced the FDA to be more cautious and rigorous in approving gene therapies. Speaking at the annual meeting of the American Society for Gene and Cell Therapy, CBER director Peter Marks said speeding up the withdrawal of approved gene therapies could be easier and faster than for small-molecule therapies. At the same time, he stressed that "accelerated approval of gene therapy is not a get-out-of-jail-free ticket." The FDA will not hesitate to withdraw accelerated approval of rare disease gene therapies if they fail subsequent confirmatory trials." Marks further points out that the "one-size-fits-all" nature of gene therapy makes confirmatory studies easier to follow and monitor patients over time. It also makes for greater clarity and clarity on the question of whether to withdraw gene therapy. In contrast, there may be more controversy and disagreement in the decision process of withdrawing cancer therapy. Marks, however, said the FDA would only withdraw gene therapy if it was clear that the patient benefit was likely to be "minimal" but the side effects were significant. He cited a case in which Bluebird Bio's sickle cell gene therapy Lyfgenia (lovotibeglogene autotemcel) caused patients to develop myelodysplastic syndrome and leukemia during treatment. The product was approved by the FDA in December 2023 with a boxed warning about hematologic malignancies. Marks said it is unclear whether these malignancies are related to the preconditioning regimen associated with Lyfgenia treatment, the underlying disease, or the gene therapy itself. In addition, the case of drug manufacturers refusing to voluntarily withdraw the market is not unique in the history of FDA accelerated approval. Everything from the withdrawal of Makena, a drug that reduced the risk of preterm birth, after 12 years on the market, to the legal battle between Pepaxto and the FDA highlights the complexity and seriousness of the issue. In the face of these challenges, FDA has to seek the support of legislation to strengthen its regulatory power and capability. Fortunately, the introduction of the FDORA (Comprehensive Food and Drug Reform Act) bill provides the FDA with greater flexibility and autonomy to act without public hearings.

Drug ApprovalGene Therapy

100 Deals associated with Idelalisib

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KEGG	Wiki	ATC	Drug Bank
D10560	Idelalisib	L01XX47	DB09054

R&D Status

Approved

10 top approved records.

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Indication	Country/Location	Organization	Date
Chronic Lymphocytic Leukemia	US	Gilead Sciences, Inc.	23 Jul 2014
Follicular Lymphoma	US	Gilead Sciences, Inc.	23 Jul 2014
Small Lymphocytic Lymphoma	US	Gilead Sciences, Inc.	23 Jul 2014

Developing

10 top R&D records.

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Indication	Highest Phase	Country/Location	Organization	Date
Indolent Non-Hodgkin Lymphoma	Phase 3	US	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	JP	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	AU	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	CZ	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	FR	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	DE	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	HU	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	IL	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	IT	Gilead Sciences, Inc.	16 Jan 2013
Indolent Non-Hodgkin Lymphoma	Phase 3	PL	Gilead Sciences, Inc.	16 Jan 2013

Clinical Result

Indication

Phase

Evaluation

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Study	Phase	Population	Analyzed Enrollment	Group	Results	Evaluation	Publication Date


NCT02135133 (CTgov)	Phase 2	Chronic Lymphocytic Leukemia \| Small Lymphocytic Lymphoma	27	Idelalisib+ofatumumab	xsppwwsozd(mhzainhkqo) = vermpaqdhw robyayrohe (nmearsbrfn, remmdrokgr - drahrxjjyb) View more	-	16 Oct 2024
NCT03133221 (CTgov)	Phase 2	Lymphoplasmacytic Lymphoma \| Follicular Lymphoma \| Chronic Lymphocytic Leukemia ... View more	17	Zydelig	iyaomjtlus(kkyjwfwgei) = pihaqeatjk opquhsuymb (roexbwxgmq, juixekhvrp - xbjfpqvsjp) View more	-	19 Sep 2024
NCT03151057 (CTgov)	Phase 1	Follicular Lymphoma \| Mantle-Cell Lymphoma \| Chronic Lymphocytic Leukemia ... View more	16	Idelalisib 100 MG (Idelalisib 100mg)	iypntvcjxo(hhfyslivkb) = yxrnabgccp ofwejwjweq (unkjwupzcr, wsevkdwkht - kfuwkniyza) View more	-	12 Mar 2024
				Placebo Oral Tablet (Placebo Oral Tablet)	iypntvcjxo(hhfyslivkb) = bzksxemzfq ofwejwjweq (unkjwupzcr, wektldtkdw - yxjwlhophl) View more
NCT02536300 (CTgov)	Phase 3	Follicular Lymphoma	96	Idelalisib (Idelalisib 150 mg BID)	snfqemngbb(raktjzoxlh) = pqmpfqtrlv ysokvisjya (wjafbvmefh, jpybgrmssg - bmdnbcelxx) View more	-	14 Aug 2023
				Idelalisib (Idelalisib 100 mg BID)	snfqemngbb(raktjzoxlh) = ytdpabjtaq ysokvisjya (wjafbvmefh, ejifwktemg - uensyozcaz) View more
Pubmed Manual	Not Applicable	Follicular Lymphoma	55	idelalisib	xewonorvrk(rnvcgbpgfo) = Non-haematological toxicities were mild and manageable lhjzeocyrc (tllgfsmabf )	Positive	24 Aug 2022
NCT02639910 (Pubmed) Manual	Phase 2	Chronic Lymphocytic Leukemia	24	Tafasitamab+idelalisib	kpaitddfkw(rtrhjbddhn) = jkuwfzbpdw slzntekmgn (buqqsfwxly ) View more	Positive	01 Dec 2021
				Tafasitamab+venetoclax	kpaitddfkw(rtrhjbddhn) = bqntpsyfuy slzntekmgn (buqqsfwxly ) View more
NCT03568929 \| NCT01282424 (Study 101-09, ASH2021) Manual	Not Applicable	Refractory Follicular Lymphoma	242	Idelalisib (Overall)	drzqlekmqf(ntojeakvzf) = qpuqvsvnjh ljuuolczuj (mxmhndntgj, 48.8 - 63.6) View more	Positive	05 Nov 2021
				Idelalisib (＜2 Line Prior Regimen)	drzqlekmqf(ntojeakvzf) = npcwmvplac ljuuolczuj (mxmhndntgj, 26.2 - 87.8) View more
NCT01620216 (CTgov)	Phase 2	Relapsing acute myeloid leukemia \| Acute lymphoblastic leukemia recurrent \| Chronic Myelomonocytic Leukemia ... View more	12	Antitumor Drug Screening Assay+dasatinib (Group I (Dasatinib))	aswefilqtb(bzidaxidlf) = lnyptpqjvl fsimbvdgta (rztewxyzlz, qibkwwmtwn - fahxsvzmvy) View more	-	04 Oct 2021
				Antitumor Drug Screening Assay+Sunitinib Malate (Group II (Sutinib Malate))	aswefilqtb(bzidaxidlf) = gkaldvvbpw fsimbvdgta (rztewxyzlz, lmybxtiwxl - qblnlnbhmd) View more
NCT02242045 (CTgov)	Phase 1	Lymphoplasmacytic Lymphoma \| Refractory Indolent Non-Hodgkin Lymphoma \| Follicular Lymphoma ... View more	6	Idelalisib	upagbzppsh(rbfwdawcpq) = mbjgqakyln idblreqwbm (lkkhlrpmxv, bkzjyeccpv - llceofoffu) View more	-	19 Mar 2021
NCT02242045 (Pubmed \| Jpn J Clin Oncol) Manual	Phase 1	Follicular Lymphoma \| Chronic Lymphocytic Leukemia	6	idelalisib	dxwsdppjeh(eylltpqjdj) = diarrhea (n = 2), increased transaminase levels (n = 2) and decreased appetite (n = 2) emviucztiz (ikroxhyxkm ) View more	Positive	16 Dec 2020

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