Unfortunately not a single drug out there has 100% strike rate. Thats why there is so many different drugs on the market that treat the same condition, as drug A might not work (or could be less effective) for 10-15% of the population but drug B would.
As someone who worked in medical research I can say the vast majority of trials for these kind of drugs are done on healthy adults under the age of 50 under fasting conditions and they also make sure the participants are not on any other medications (that could cause drug interactions) The reason for that is they need to demonstrate that the drug actually works on the largest demographics. Once they get the regulatory approvals then they can use the real life data to look into the small percentage pf patients that's this may not be suitable for.
Just my 2 cents
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