RT Journal Article SR Electronic T1 Bremelanotide and flibanserin for low sexual desire in women: the fallacy of regulatory precedent JF Drug and Therapeutics Bulletin JO Drug Ther Bull FD BMJ Publishing Group Ltd SP 185 OP 188 DO 10.1136/dtb.2021.000020 VO 59 IS 12 A1 Mintzes, Barbara A1 Tiefer, Leonore A1 Cosgrove, Lisa YR 2021 UL http://dtb.bmj.com/content/59/12/185.abstract AB The US Food and Drug Administration (FDA) has approved two drugs for ‘hypoactive sexual desire disorder’ in women, flibanserin (Addyi) in 2015 and bremelanotide (Vyleesi) in 2019. In this paper we examine the outcome measures and clinical trial data upon which regulatory approval was based. In clinical trials, flibanserin led to an average of only one additional enjoyable sexual experience every two months, bremelanotide to none. Trials for both drugs feature shifts in primary outcomes and a contested indication. A politicised industry-sponsored advocacy campaign and conflicted patient and expert testimony likely influenced flibanserin’s approval at its third attempt. Bremelanotide, with even weaker efficacy, capitalised on the regulatory precedent set by the approval of flibanserin. Reconsideration of regulatory decisions to approve these drugs is in order, as well as a broader examination of how future regulatory decisions can better address conflicts of interest and clinically meaningful benefit.