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Douaisi M, Paskaleva EE, Fu L, Grover N, McManaman CL, Varghese S, Brodfuehrer PR, Gibson JM, de Joode I, Xia K, Brier MI, Simmons TJ, Datta P, Zhang F, Onishi A, Hirakane M, Mori D, Linhardt RJ, Dordick JS. Synthesis of bioengineered heparin chemically and biologically similar to porcine-derived products and convertible to low MW heparin. Proc Natl Acad Sci U S A 2024; 121:e2315586121. [PMID: 38498726 PMCID: PMC10998570 DOI: 10.1073/pnas.2315586121] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Accepted: 01/21/2024] [Indexed: 03/20/2024] Open
Abstract
Heparins have been invaluable therapeutic anticoagulant polysaccharides for over a century, whether used as unfractionated heparin or as low molecular weight heparin (LMWH) derivatives. However, heparin production by extraction from animal tissues presents multiple challenges, including the risk of adulteration, contamination, prion and viral impurities, limited supply, insecure supply chain, and significant batch-to-batch variability. The use of animal-derived heparin also raises ethical and religious concerns, as well as carries the risk of transmitting zoonotic diseases. Chemoenzymatic synthesis of animal-free heparin products would offer several advantages, including reliable and scalable production processes, improved purity and consistency, and the ability to produce heparin polysaccharides with molecular weight, structural, and functional properties equivalent to those of the United States Pharmacopeia (USP) heparin, currently only sourced from porcine intestinal mucosa. We report a scalable process for the production of bioengineered heparin that is biologically and compositionally similar to USP heparin. This process relies on enzymes from the heparin biosynthetic pathway, immobilized on an inert support and requires a tailored N-sulfoheparosan with N-sulfo levels similar to those of porcine heparins. We also report the conversion of our bioengineered heparin into a LMWH that is biologically and compositionally similar to USP enoxaparin. Ultimately, we demonstrate major advances to a process to provide a potential clinical and sustainable alternative to porcine-derived heparin products.
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Affiliation(s)
- Marc Douaisi
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Elena E. Paskaleva
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Li Fu
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Navdeep Grover
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Charity L. McManaman
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Sony Varghese
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Paul R. Brodfuehrer
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - James M. Gibson
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Ian de Joode
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Ke Xia
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Matthew I. Brier
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Trevor J. Simmons
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Payel Datta
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Fuming Zhang
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Akihiro Onishi
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Makoto Hirakane
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Daisuke Mori
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Robert J. Linhardt
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Chemistry and Chemical Biology, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY12180
| | - Jonathan S. Dordick
- Center for Biotechnology and Interdisciplinary Studies, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Chemical and Biological Engineering, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Biomedical Engineering, Rensselaer Polytechnic Institute, Troy, NY12180
- Department of Biological Sciences, Rensselaer Polytechnic Institute, Troy, NY12180
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Parmar A, Sahu DP, Behera P. Burden of alcohol use and inclusion of alcohol use disorder medications in the essential medicine lists across 132 countries: An observational study. Alcohol 2024:S0741-8329(24)00033-8. [PMID: 38423262 DOI: 10.1016/j.alcohol.2024.02.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/21/2023] [Revised: 02/11/2024] [Accepted: 02/23/2024] [Indexed: 03/02/2024]
Abstract
Harmful use of alcohol effects the health of the population. The treatment coverage of alcohol use disorders (AUD) varies among countries. The study aimed to determine the inclusion of AUD medicines in various national Essential Medicine Lists (EMLs) and its association with alcohol consumption. It was a secondary data analysis of alcohol consumptions and AUD related medicines in EML. Data were extracted from the WHO Global Essential Medicines database and the WHO Global Status Report on Alcohol and Health 2018. Data were extracted for 194 countries. Only 132 of 194 countries (68.0%) had EML, and among the 132 countries only 27.3% had included AUD medicines in their EML. Only 36 countries had included any of the AUD medicines in their EML. Disulfiram was included by 23 countries, while Acamprosate and Naltrexone was included by only four and 19 countries, respectively. Among the countries, 36.1% were from upper-middle income countries and 16.65 from low-income countries. The inclusion of AUD medicines in national EML was neither associated with alcohol consumption parameters nor the alcohol consumption related policy parameters. Considering the high prevalence of AUD and its complications, there is an urgent need to focus on including AUD medicines in national EML for making AUD treatment available and accessible across the world.
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Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
| | | | - Priyamadhaba Behera
- Department of Community Medicine and Family Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India.
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Piggott T, Moja L, Jenei K, Kredo T, Skoetz N, Banzi R, Trapani D, Leong T, McCaul M, Lavis JN, Akl EA, Nonino F, Iorio A, Laurson-Doube J, Huttner BD, Schünemann HJ. GRADE Concept 7: Issues and Insights Linking Guideline Recommendations to Trustworthy Essential Medicine Lists. J Clin Epidemiol 2024; 166:111241. [PMID: 38123105 PMCID: PMC10939133 DOI: 10.1016/j.jclinepi.2023.111241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/24/2023] [Revised: 12/10/2023] [Accepted: 12/14/2023] [Indexed: 12/23/2023]
Abstract
OBJECTIVES Guidelines and essential medicine lists (EMLs) bear similarities and differences in the process that lead to decisions. Access to essential medicines is central to achieve universal health coverage. The World Health Organization (WHO) EML has guided prioritization of essential medicines globally for nearly 50 years, and national EMLs (NEMLs) exist in over 130 countries. Guideline and EML decisions, at WHO or national levels, are not always coordinated and aligned. We sought to explore challenges, and potential solutions, for decision-making to support trustworthy medicine selection for EMLs from a Grading of Recommendations, Assessment, Development and Evaluations (GRADE) Working Group perspective. We primarily focus on the WHO EML; however, our findings may be applicable to NEML decisions as well. STUDY DESIGN AND SETTING We identified key challenges in connecting the EML to health guidelines by involving a broad group of stakeholders and assessing case studies including real applications to the WHO EML, South Africa NEML, and a multiple sclerosis guideline connected to a WHO EML application for multiple sclerosis treatments. To address challenges, we utilized the results of a survey and feedback from the stakeholders, and iteratively met as a project group. We drafted a conceptual framework of challenges and potential solutions. We presented a summary of the results for feedback to all attendees of the GRADE Working Group meetings in November 2022 (approximately 120 people) and in May 2023 (approximately 100 people) before finalizing the framework. RESULTS We prioritized issues and insights/solutions that addressed the connections between the EML and health guidelines. Our suggested solutions include early planning alignment of guideline groups and EMLs, considering shared participation to strengthen linkage, further clarity on price/cost considerations, and using explicit shared criteria to make guideline and EML decisions. We also provide recommendations to strengthen the connection between WHO EML and NEMLs including through contextualization methods. CONCLUSION This GRADE concept article, jointly developed by key stakeholders from the guidelines and EMLs field, identified key conceptual issues and potential solutions to support the continued advancement of trustworthy EMLs. Adopting structured decision criteria that can be linked to guideline recommendations bears the potential to advance health equity and gaps in availability of essential medicines within and between countries.
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Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Family Medicine, Queens University, Kingston, Canada.
| | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Kristina Jenei
- Department of Health Policy, London School of Economics and Political Science, London, United Kingdom
| | - Tamara Kredo
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa; Division of Clinical Pharmacology, Department of Medicine and Division of Epidemiology and Biostatistics, Department of Global Health, Faculty of Medicine and Health Sciences, Stellenbosch University, Stellenbosch, South Africa
| | - Nicole Skoetz
- Institute of Public Health, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany
| | - Rita Banzi
- Mario Negri Institute for Pharmacological Research, IRCCS, Milan, Italy
| | - Dario Trapani
- Department of Oncology and Hematology, University of Milan, Milan, Italy; European institute of oncology, IRCCS, Milan, Italy
| | - Trudy Leong
- Health Systems Research Unit, South African Medical Research Council, Cape Town, South Africa
| | - Michael McCaul
- Division of Epidemiology and Biostatistics, Department of Global Health, Centre for Evidence-Based Health Care, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - John N Lavis
- McMaster Health Forum, McMaster University, Hamilton, Canada; Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Internal Medicine, American University of Beirut, Beirut, Lebanon
| | - Francesco Nonino
- IRCCS Istituto delle Scienze Neurologiche di Bologna, Unit of Epidemiology and Statistics, Bologna, Italy; WHO Collaborating Centre in Evidence-Based Research Synthesis and Guideline Development, Regione Emilia-Romagna, Bologna, Italy
| | - Alfonso Iorio
- Department of Research Methods, Evidence, and Impact, Mike Gent Chair in Healthcare Research, McMaster University, Hamilton, Canada
| | | | - Benedikt D Huttner
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Medicine, McMaster University, Hamilton, Canada.
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Piggott T, Moja L, Garcia CAC, Akl EA, Banzi R, Huttner B, Kredo T, Lavis JN, Schünemann HJ. User-experience testing of an evidence-to-decision framework for selecting essential medicines. PLOS GLOBAL PUBLIC HEALTH 2024; 4:e0002723. [PMID: 38206901 PMCID: PMC10783770 DOI: 10.1371/journal.pgph.0002723] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/07/2022] [Accepted: 11/22/2023] [Indexed: 01/13/2024]
Abstract
Essential medicine lists (EMLs) are important medicine prioritization tools used by the World Health Organization (WHO) EML and over 130 countries. The criteria used by WHO's Expert Committee on the Selection and Use of Essential Medicines has parallels to the GRADE Evidence-to-Decision (EtD) frameworks. In this study, we explored the EtD frameworks and a visual abstract as adjunctive tools to strengthen the integrate evidence and improve the transparency of decisions of EML applications. We conducted user-experience testing interviews of key EML stakeholders using Morville's honeycomb model. Interviews explored multifaceted dimensions (e.g., usability) on two EML applications for the 2021 WHO EML-long-acting insulin analogues for diabetes and immune checkpoint inhibitors for lung cancer. Using a pre-determined coding framework and thematic analysis we iteratively improved both the EtD framework and the visual abstract. We coded the transcripts of 17 interviews with 13 respondents in 103 locations of the interview texts across all dimensions of the user-experience honeycomb. Respondents felt the EtD framework and visual abstract presented complementary useful and findable adjuncts to the traditional EML application. They felt this would increase transparency and efficiency in evidence assessed by EML committees. As EtD frameworks are also used in health practice guidelines, including those by the WHO, respondents articulated that the adoption of the EtD by EML applications represents a tangible mechanism to align EMLs and guidelines, decrease duplication of work and improve coordination. Improvements were made to clarify instructions for the EtD and visual abstract, and to refine the design and content included. 'Availability' was added as an additional criterion for EML applications to highlight this criterion in alignment with WHO EML criteria. EtD frameworks and visual abstracts present additional important tools to communicate evidence and support decision-criteria in EML applications, which have global health impact. Access to essential medicines is important for achieving universal health coverage, and the development of essential medicine lists should be as evidence-based and trustworthy as possible.
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Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Family Medicine, Queens University, Kingston, ON, Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Carlos A. Cuello Garcia
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
| | - Elie A. Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - Rita Banzi
- Mario Negri Institute for Pharmacological Research IRCCS, Milan, Italy
| | - Benedikt Huttner
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa
- Department of Medicine, and Epidemiology and Biostatistics, Department of Global Health, Clinical Pharmacology, Stellenbosch University, Cape Town, South Africa
| | - John N. Lavis
- McMaster Health Forum, McMaster University, Hamilton, ON, Canada
- Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Holger J. Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, ON, Canada
- Department of Biomedical Sciences, Humanitas University, Milan, Italy
- Department of Medicine, McMaster University, Hamilton, ON, Canada
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5
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Costa E, Moja L, Wirtz VJ, van den Ham HA, Huttner B, Magrini N, Leufkens HGM. Uptake of orphan drugs in the WHO essential medicines lists. Bull World Health Organ 2024; 102:22-31. [PMID: 38164340 PMCID: PMC10753278 DOI: 10.2471/blt.23.289731] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2023] [Revised: 07/31/2023] [Accepted: 09/13/2023] [Indexed: 01/03/2024] Open
Abstract
Objective We evaluated the uptake of medicines licensed as orphan drugs by the United States Food and Drug Administration (FDA) or European Medicines Agency (EMA) into the WHO Model list of essential medicines and the WHO Model list of essential medicines for children from 1977 to 2021. Methods We collated and analysed data on drug characteristics, reasons for adding or rejecting medicines, and time between regulatory approval and inclusion in the lists. We compared trends in listing orphan drugs before and after revisions to the inclusion criteria of the essential medicines lists in 2001, as well as differences in trends for listing orphan and non-orphan drugs, respectively. Findings The proportion of orphan drugs in the essential medicines lists increased from 1.9% (4/208) in 1977 to 14.6% (70/478) in 2021. While orphan drugs for communicable diseases have remained stable over time, we observed a considerable shift towards more orphan drugs for noncommunicable diseases, particularly for cancer. The median period for inclusion in the essential medicines lists after either FDA or EMA first approval was 13.5 years (range: 1-28 years). Limited clinical evidence base and uncertainty about the magnitude of net benefit were the most frequent reasons to reject proposals to add new orphan drugs to the essential medicines lists. Conclusion Despite lack of a global definition of rare diseases, the essential medicines lists have broadened their scope to include medicines for rare conditions. However, the high costs of many listed orphan drugs pose accessibility and reimbursement challenges in resource-constrained settings.
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Affiliation(s)
- Enrico Costa
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Department of Pharmacoepidemiology, Utrecht University, Utrecht, Kingdom of the Netherlands
| | - Lorenzo Moja
- Secretariat of the Expert Committee on the Selection and Use of Essential Medicines, Department of Health Products Policy and Standards, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Veronika J Wirtz
- WHO Collaborating Centre in Pharmaceutical Policy, Department of Global Health, Boston University, Boston, United States of America
| | - Hendrika A van den Ham
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Department of Pharmacoepidemiology, Utrecht University, Utrecht, Kingdom of the Netherlands
| | - Benedikt Huttner
- Secretariat of the Expert Committee on the Selection and Use of Essential Medicines, Department of Health Products Policy and Standards, World Health Organization, 20 Avenue Appia, 1211Geneva, Switzerland
| | - Nicola Magrini
- WHO Collaborating Centre for Evidence-Based Research Synthesis and Guideline Development, Emilia-Romagna Health Authority, Bologna, Italy
| | - Hubert GM Leufkens
- WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Department of Pharmacoepidemiology, Utrecht University, Utrecht, Kingdom of the Netherlands
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Petro E, Perumal-Pillay V, Mantel-Teeuwisse AK, van den Ham HA, Suleman F. Evaluation of alignment of the reimbursement medicines list for children in Albania with the WHO essential medicines list for children. J Pharm Policy Pract 2023; 17:2290100. [PMID: 38205189 PMCID: PMC10775712 DOI: 10.1080/20523211.2023.2290100] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2024] Open
Abstract
Background The WHO Essential Medicine List for Children was released on the 30th anniversary of the general Essential Medicine List in 2007, to recognise special needs for medicines in children, and to promote the inclusion of paediatric medicines in national procurement programmes. This study aimed to investigate the alignment of the medicines included in the Albanian reimbursement medicines list of the Mandatory Healthcare Insurance Fund (AMHIF) and the Essential Medicine List for Children. Methods A quantitative evaluation was performed to compare the paediatric medicines included in the 2022 list of the AMHIF and the 2021 WHO Essential Medicine List for Children. In addition, vaccines in the Albanian vaccination programmes for children were compared to the ones listed on the WHO Essential Medicine List for Children. Results Both lists had a total of 284 active ingredients in common, whereas 14 of 24 vaccines were found to be in common in the Essential Medicine List for Children list and the Albanian vaccination programmes. Conclusions This is the first study in Albania to investigate the alignment of the WHO EMLc and AMHIF list. In case of the same active ingredient there were many deviations in terms of dosage form, strength and indication.
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Affiliation(s)
- E. Petro
- Local Healthcare Unit, Durres, Albania
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - V. Perumal-Pillay
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - A. K. Mantel-Teeuwisse
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - H. A. van den Ham
- Utrecht WHO Collaborating Centre for Pharmaceutical Policy and Regulation, Division of Pharmacoepidemiology and Clinical Pharmacology, Utrecht Institute for Pharmaceutical Sciences (UIPS), Utrecht University, Utrecht, the Netherlands
| | - F. Suleman
- WHO Collaborating Centre for Pharmaceutical Policy and Evidence Based Practice, Discipline of Pharmaceutical Sciences, School of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
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Modiba WK, Katerere DR, Mncwangi NP. A desktop review of evaluation of implementation of national medicines policies in SADC countries. Heliyon 2023; 9:e22218. [PMID: 38045165 PMCID: PMC10692818 DOI: 10.1016/j.heliyon.2023.e22218] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 11/06/2023] [Accepted: 11/07/2023] [Indexed: 12/05/2023] Open
Abstract
A national medicine policy (NMP), formerly referred to as a national drug policy (NDP) is a document that serves as a political commitment and guide for action by the government to provide safe, efficacious, quality assured, available, affordable and rationally used medicines. This is the first study to review the implemented components of the NMPs of the 16 South African Development Community (SADC) countries over the past ten years (2011-2021). Information published between 2011 and 2021 of each country such as pharmaceutical profiles, official government documents, WHO/HAI/World Bank datasets and research studies on the implemented components were appraised. Significant progress has been made by 16 SADC countries over the period 2011-2021 in implementing the NMP. The most commonly implemented components included the concept of essential medicines, pricing, and regulation. Though traditional and herbal medicines component is yet to be implemented by the majority. The pharmacist-patient ratio of 1:2300 was below the target for all countries, prompting the need to strengthen the pharmacy personnel in the healthcare systems. Medicine pricing, affordability, and availability studies are necessary to develop equitable pricing policies that will improve the accessibility of medicines in all countries and the SADC region. With the exception of the Republic of Tanzania, SADC countries need to urgently revise their NMPs, thus adopting progressive processes such as incorporating Health Technology Assessment (HTA) in the NMP. All SADC countries require a strong, internationalistic evaluation culture built-in their policy formulation. As the first study to investigate the implemented NMPs in the SADC region, it could serve as a springboard for the countries to address their common pharmaceutical challenges thus improving their readiness for universal health coverage (UHC). Future in-depth cross-country studies in the SADC region are necessary to comprehensively evaluate the implemented components of NMPs.
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Affiliation(s)
- William K. Modiba
- Tshwane University of Technology, Department of Pharmaceutical Sciences, Faculty of Science, Private Bag X680, Pretoria, 0001, South Africa
| | - David R. Katerere
- Tshwane University of Technology, Department of Pharmaceutical Sciences, Faculty of Science, Private Bag X680, Pretoria, 0001, South Africa
| | - Nontobeko P. Mncwangi
- Sefako Makgatho Health Sciences University, School of Pharmacy, Faculty of Medicine, Medunsa, 0204, South Africa
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Ikpeni O(T, Maraj D, Woods H, Workentin A, Booth CM, Persaud N. Essential cancer medicines and cancer outcomes: Cross-sectional study of 124 countries. Cancer Med 2023; 12:20745-20758. [PMID: 37902259 PMCID: PMC10709725 DOI: 10.1002/cam4.6642] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2022] [Revised: 08/03/2023] [Accepted: 10/12/2023] [Indexed: 10/31/2023] Open
Abstract
BACKGROUND Cancer is the second leading cause of death worldwide. Alongside other interventions, access to certain medicines may decrease cancer-associated mortality. Listing medicines on national essential medicines lists may improve health outcomes. We examine the association between cancer mortality amenable to care and the listing of cancer medicines on national essential medicines lists (NEMLs) of 124 countries. METHODS In this cross-sectional study, we determined the number of medicines used to treat eight cancers on NEMLs and used multiple linear regression to analyze the association between cancer health outcome scores and the number of medicines on NEMLs while controlling for GDP. A sensitivity analysis was also conducted using selected medicines. FINDINGS The number of cancer medicines on NEMLs was not associated with cancer health outcome scores when GDP was controlled for non-melanoma skin (p = 0.224), uterine (p = 0.221), breast (p = 0.145), Hodgkin's lymphoma (p = 0.697), colon (p = 0.299), leukemia (p = 0.103), cervical (p = 0.834), and testicular cancers (p = 0.178). INTERPRETATION There was a weak association between listing medicines for eight cancers in NEMLs and amenable mortality. Further studies are required to explore association between cancer health outcomes and other factors such as actual availability of medicines listed, access to surgeries, accurate diagnosis, radiotherapy, and early detection.
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Affiliation(s)
| | - Darshanand Maraj
- MAP Centre for Urban Health SolutionsSt. Michael's HospitalTorontoOntarioCanada
| | - Hannah Woods
- MAP Centre for Urban Health SolutionsSt. Michael's HospitalTorontoOntarioCanada
| | - Aine Workentin
- MAP Centre for Urban Health SolutionsSt. Michael's HospitalTorontoOntarioCanada
| | | | - Nav Persaud
- MAP Centre for Urban Health SolutionsSt. Michael's HospitalTorontoOntarioCanada
- Department of Family and Community MedicineUniversity of TorontoTorontoOntarioCanada
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Petrella A, Fortinguerra F, Cangini A, Pierantozzi A, Trotta F. Access and use of WHO essential medicines in Italy. Front Public Health 2023; 11:1211208. [PMID: 37881343 PMCID: PMC10595003 DOI: 10.3389/fpubh.2023.1211208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Accepted: 09/13/2023] [Indexed: 10/27/2023] Open
Abstract
Background Many countries use the WHO Essential Medicines List (EML) as a guide for health policy choices to promote the efficient use of healthcare resources or adopt the concept of essential medicines (EMs) to develop their own national list of essential medicines. The aim of this study is to analyse the availability and use of medicines included in the 22nd WHO EML in Italy. Methods Using the ATC code (5th level), a comparison was made between the medicines included in the WHO EML and those retrieved from the Italian Medicines Agency (AIFA) database. The availability (regulatory and reimbursement status) of EMs, as well as the market share in expenditure (million euros) and consumption [measured in WHO-defined daily doses (DDDs)], compared to all reimbursed medicines in 2021, were analysed. Results In 2021, approximately 85.2% (n = 414) of medicines included in the WHO EML were commonly marketed in Italy. Of these, 396 EMs were fully reimbursed by the Italian National Healthcare Service (INHS), corresponding to 81.5% (396/486) of the WHO EML, while the remaining 18.5% (90/486) were neither authorised (n = 72) nor reimbursed (n = 18). The study found a low coverage for anti-parasitic, insecticides, and repellent products (ATC P) in addition to medicines for the genitourinary system and sex hormones (ATC G). Even though medicines on the WHO EML, including therapeutic alternatives, accounted for ~48.5% of the expenditure for medicines reimbursed by INHS, the list covered 74% of all national drug consumed. Novel high-cost therapies indicated in high-prevalence diseases and rare conditions, mostly antineoplastic and immune-modulating agents (ATC L) not included in the WHO EML, were also guaranteed. Conclusions In Italy, high coverage of EMs was found. It was largely reimbursed by the INHS, even when compared to other European countries. Essential medicines represented a high percentage of the overall expenditure and consumption in Italy. The WHO EML could be an important tool to guide the health policy choices of high-income countries, although a more frequent update and easier access to information on rejected medicines are needed.
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Aronson JK, Heneghan C, Ferner RE. Drug shortages. Part 1. Definitions and harms. Br J Clin Pharmacol 2023; 89:2950-2956. [PMID: 37455356 DOI: 10.1111/bcp.15842] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/04/2023] [Revised: 06/10/2023] [Accepted: 06/20/2023] [Indexed: 07/18/2023] Open
Abstract
Drug shortages are repeatedly in the news. The earliest drug shortages were reported during the First World War, but the numbers of shortages have increased in recent years. In the first part of this two-part review, we discuss definitions of drug shortages and so-called stockouts, which are localized shortages, and the harms that they can cause. Drug shortages make it difficult or impossible to meet the therapeutic needs of individual patients or populations, but we lack an adequate definition. The problems are too complicated to be encompassed in a brief intensional dictionary-style definition, and that is reflected in the many different attempts at definition that have been proposed. We therefore propose an extensional operational definition that incorporates the processes by which products are manufactured, the causes of shortages and the contributory factors. A definition of this sort allows one to identify the main causes of a particular drug shortage and therefore the remedies that might prevent, mitigate or manage it. In the second part of the review we discuss the causes and solutions in more detail. Adverse drug reactions and medication errors attributable to shortages occur but are not often reported. Adverse reactions to substitute medicines are possible, and errors can occur because of unfamiliarity or unnecessary treatment with replacement medicines. Other harmful outcomes include withdrawal reactions, undertreatment, treatment delays and cancellations, failure of alternatives and disruption of clinical trials.
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Affiliation(s)
- Jeffrey K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Carl Heneghan
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - Robin E Ferner
- West Midlands Centre for Adverse Drug Reactions, City Hospital, Birmingham, UK
- School of Clinical and Experimental Medicine, University of Birmingham, Birmingham, UK
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11
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Brhlikova P, Persaud N, Osorio-de-Castro CGS, Pollock AM. Essential medicines lists are for high income countries too. BMJ 2023; 382:e076783. [PMID: 37669797 DOI: 10.1136/bmj-2023-076783] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 09/07/2023]
Affiliation(s)
| | - Nav Persaud
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Claudia Garcia Serpa Osorio-de-Castro
- Departamento de Política de Medicamentos e Assistência Farmacêutica, Escola Nacional de Saúde Pública Sergio Arouca, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Allyson M Pollock
- Population Health Sciences Institute, Newcastle University, Newcastle upon Tyne, UK
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12
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Gammal RS, Pirmohamed M, Somogyi AA, Morris SA, Formea CM, Elchynski AL, Oshikoya KA, McLeod HL, Haidar CE, Whirl-Carrillo M, Klein TE, Caudle KE, Relling MV. Expanded Clinical Pharmacogenetics Implementation Consortium Guideline for Medication Use in the Context of G6PD Genotype. Clin Pharmacol Ther 2023; 113:973-985. [PMID: 36049896 PMCID: PMC10281211 DOI: 10.1002/cpt.2735] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2022] [Accepted: 08/26/2022] [Indexed: 11/06/2022]
Abstract
Glucose-6-phosphate dehydrogenase (G6PD) deficiency is associated with development of acute hemolytic anemia in the setting of oxidative stress, which can be caused by medication exposure. Regulatory agencies worldwide warn against the use of certain medications in persons with G6PD deficiency, but in many cases, this information is conflicting, and the clinical evidence is sparse. This guideline provides information on using G6PD genotype as part of the diagnosis of G6PD deficiency and classifies medications that have been previously implicated as unsafe in individuals with G6PD deficiency by one or more sources. We classify these medications as high, medium, or low to no risk based on a systematic review of the published evidence of the gene-drug associations and regulatory warnings. In patients with G6PD deficiency, high-risk medications should be avoided, medium-risk medications should be used with caution, and low-to-no risk medications can be used with standard precautions, without regard to G6PD phenotype. This new document replaces the prior Clinical Pharmacogenetics Implementation Consortium guideline for rasburicase therapy in the context of G6PD genotype (updates at: www.cpicpgx.org).
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Affiliation(s)
- Roseann S. Gammal
- Department of Pharmacy Practice, Massachusetts College of Pharmacy and Health Sciences, Boston, MA, USA
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Munir Pirmohamed
- MRC Centre for Drug Safety Science, Department of Pharmacology and Therapeutics, Institute of Systems, Molecular and Integrative Biology, University of Liverpool, Liverpool, United Kingdom
| | - Andrew A. Somogyi
- Discipline of Pharmacology, School of Biomedicine, Faculty of Health and Medical Sciences, University of Adelaide, Adelaide, Australia
| | - Sarah A. Morris
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
- Department of Cancer Pharmacology and Pharmacogenomics, Levine Cancer Institute, Atrium Health, Charlotte, NC, USA
| | - Christine M. Formea
- Department of Pharmacy and Intermountain Precision Genomics, Intermountain Healthcare, Salt Lake City, UT, USA
| | | | - Kazeem A. Oshikoya
- Department of Pharmacology, Therapeutics and Toxicology, College of Medicine, Lagos State University, Ikeja, Lagos, Nigeria
| | - Howard L. McLeod
- Intermountain Precision Genomics, Intermountain Healthcare, St George, UT, USA
| | - Cyrine E. Haidar
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | | | - Teri E. Klein
- Department of Biomedical Data Science, Stanford University, Stanford, CA, USA
| | - Kelly E. Caudle
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
| | - Mary V. Relling
- Department of Pharmacy and Pharmaceutical Sciences, St. Jude Children’s Research Hospital, Memphis, TN, USA
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13
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Kim E, Kim HC, Van Reet J, Böhlke M, Yoo SS, Lee W. Transcranial focused ultrasound-mediated unbinding of phenytoin from plasma proteins for suppression of chronic temporal lobe epilepsy in a rodent model. Sci Rep 2023; 13:4128. [PMID: 36914775 PMCID: PMC10011522 DOI: 10.1038/s41598-023-31383-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/25/2022] [Accepted: 03/10/2023] [Indexed: 03/16/2023] Open
Abstract
The efficacy of many anti-epileptic drugs, including phenytoin (PHT), is reduced by plasma protein binding (PPB) that sequesters therapeutically active drug molecules within the bloodstream. An increase in systemic dose elevates the risk of drug side effects, which demands an alternative technique to increase the unbound concentration of PHT in a region-specific manner. We present a low-intensity focused ultrasound (FUS) technique that locally enhances the efficacy of PHT by transiently disrupting its binding to albumin. We first identified the acoustic parameters that yielded the highest PHT unbinding from albumin among evaluated parameter sets using equilibrium dialysis. Then, rats with chronic mesial temporal lobe epilepsy (mTLE) received four sessions of PHT injection, each followed by 30 min of FUS delivered to the ictal region, across 2 weeks. Two additional groups of mTLE rats underwent the same procedure, but without receiving PHT or FUS. Assessment of electrographic seizure activities revealed that FUS accompanying administration of PHT effectively reduced the number and mean duration of ictal events compared to other conditions, without damaging brain tissue or the blood-brain barrier. Our results demonstrated that the FUS technique enhanced the anti-epileptic efficacy of PHT in a chronic mTLE rodent model by region-specific PPB disruption.
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Affiliation(s)
- Evgenii Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Hyun-Chul Kim
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
- Department of Artificial Intelligence, Kyungpook National University, Daegu, South Korea
| | - Jared Van Reet
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Mark Böhlke
- Massachusetts College of Pharmacy and Health Sciences University, Boston, MA, USA
| | - Seung-Schik Yoo
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA
| | - Wonhye Lee
- Department of Radiology, Brigham and Women's Hospital, Harvard Medical School, 75 Francis Street, Boston, MA, 02115, USA.
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14
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Allen BC, Cummer E, Sarma AK. Traumatic Brain Injury in Select Low- and Middle-Income Countries: A Narrative Review of the Literature. J Neurotrauma 2023; 40:602-619. [PMID: 36424896 DOI: 10.1089/neu.2022.0068] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022] Open
Abstract
Low- and middle-income countries (LMICs) experience the majority of traumatic brain injuries (TBIs), yet few studies have examined the epidemiology and management strategies of TBI in LMICs. The objective of this narrative review is to discuss the epidemiology of TBI within LMICs, describe the adherence to Brain Trauma Foundation (BTF) guidelines for the management of severe TBI in LMICs, and document TBI management strategies currently used in LMICs. Articles from January 1, 2009 to September 30, 2021 that included patients with TBI greater than 18 years of age in low-, low middle-, and high middle-income countries were queried in PubMed. Search results demonstrated that TBI in LMICs mostly impacts young males involved in road traffic accidents. Within LMICs there are a myriad of approaches to managing TBI with few randomized controlled trials performed within LMICs to evaluate those interventions. More studies are needed in LMICs to establish the effectiveness and appropriateness of BTF guidelines for managing TBI and to help identify methods for managing TBI that are appropriate in low-resource settings. The problem of limited pre- and post-hospital care is a bigger challenge that needs to be considered while addressing management of TBI in LMICs.
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Affiliation(s)
- Beddome C Allen
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Elaina Cummer
- Department of Pediatrics, University of Colorado Anschutz Medical Campus, Aurora, Colorado, USA
| | - Anand K Sarma
- Wake Forest School of Medicine, Winston-Salem, North Carolina, USA.,Department of Neurology, Division of Neurocritical Care, Atrium Health Wake Forest Baptist Hospital, Winston-Salem, North Carolina, USA
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15
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Piggott T, Moja L, Akl EA, Lavis JN, Cooke G, Kredo T, Hogerzeil HV, Huttner B, Alonso-Coello P, Schünemann H. Decision criteria for selecting essential medicines and their connection to guidelines: an interpretive descriptive qualitative interview study. J Clin Epidemiol 2023; 154:146-155. [PMID: 36584732 DOI: 10.1016/j.jclinepi.2022.12.007] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 11/29/2022] [Accepted: 12/08/2022] [Indexed: 12/29/2022]
Abstract
BACKGROUND AND OBJECTIVES The World Health Organization Model List of Essential Medicines has led to at least 137 national lists. Essential medicines should be grounded in evidence-based guideline recommendations and explicit decision criteria. Essential medicines should be available, accessible, affordable, and the supporting evidence should be accompanied by a rating of the certainty one can place in it. Our objectives were to identify criteria and considerations that should be addressed in moving from a guideline recommendation regarding a medicine to the decision of whether to add, maintain, or remove a medicine from an essential medicines list. We also seek to explore opportunities to improve organizational processes to support evidence-based health decision-making more broadly. METHODS We conducted a qualitative study with semistructured interviews of key informant stakeholders in the development and use of guidelines and essential medicine lists (EMLs). We used an interpretive descriptive analysis approach and thematic analysis of interview transcripts in NVIVO v12. RESULTS We interviewed 16 key informants working at national and global levels across all WHO regions. We identified five themes: three descriptive/explanatory themes 1) EMLs and guidelines, the same, but different; 2) EMLs can drive price reductions and improve affordability and access; 3) Time lag and disconnect between guidelines and EMLs; and two prescriptive themes 4) An "evidence pipeline" could improve coordination between guidelines and EMLs; 5) Facilitating the link between the WHO Model List of Essential Medicines (WHO EML) and national EMLs could increase alignment. CONCLUSION We found significant overlap and opportunities for alignment between guideline and essential medicine decision processes. This finding presents opportunities for guideline and EML developers to enhance strategies for collaboration. Future research should assess and evaluate these strategies in practice to support the shared goal of guidelines and EMLs: improvements in health.
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Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Elie A Akl
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Department of Internal Medicine, American University of Beirut Medical Centre, Beirut, Lebanon
| | - John N Lavis
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; McMaster Health Forum, McMaster University, Hamilton, Canada; Africa Centre for Evidence, University of Johannesburg, Johannesburg, South Africa
| | - Graham Cooke
- Department of Infectious Disease, Faculty of Medicine, Imperial College London, London, UK
| | - Tamara Kredo
- Cochrane South Africa, South African Medical Research Council, Cape Town, South Africa; Clinical Pharmacology, Department of Medicine, Stellenbosch University, Cape Town, South Africa
| | | | - Benedikt Huttner
- Department of Essential Medicines and Health Products, World Health Organization, Geneva, Switzerland
| | - Pablo Alonso-Coello
- Iberoamerican Cochrane Center-Servicio de Epidemiología Clínica y Salud Pública, Biomedical Research Institute (IIB-Sant Pau), Barcelona, Spain; CIBER of Epidemiology and Public Health (CIBERESP), Barcelona, Spain
| | - Holger Schünemann
- Department of Health Research Methods, Evidence, and Impact, McMaster University, Hamilton, Canada; Institut für Evidence in Medicine, Medical Center & Faculty of Medicine, University of Freiburg, Freiburg, Germany; Department of Biomedical Sciences, Humanitas University, Milan, Italy; Department of Medicine, McMaster University, Hamilton, Canada.
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16
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Rytz CL, Dumanski SM, Sola DY, Ahmed SB. The Effect of Biological Sex on Arterial Stiffness and Renin-Angiotensin-Aldosterone System Activity in Response to Cyclooxygenase-2 (COX-2) Inhibition. CJC Open 2023; 5:112-119. [PMID: 36880076 PMCID: PMC9984894 DOI: 10.1016/j.cjco.2022.11.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2022] [Accepted: 11/10/2022] [Indexed: 11/19/2022] Open
Abstract
Background Cardiovascular disease is the leading cause of death globally. Cyclooxygenase (COX)-derived prostaglandins play an important role in cardiovascular health regulation. Animal studies suggest a greater vascular dependence on prostaglandins in female subjects, but whether this extends to humans is unknown. We aimed to assess the effect of COX-2 inhibition on blood pressure and arterial stiffness, validated markers of cardiovascular risk, in human adults. Methods Healthy premenopausal females and males were studied in high-salt balance before and after 14 days of daily oral celecoxib, 200 mg ingestion, on 2 identical study days. Blood pressure (BP) and pulse-wave velocity (PWV) were measured at baseline and in response to an Angiotensin II (AngII) challenge, a validated marker of renin-angiotensin-aldosterone system activity. Results Thirteen females (age [mean ± standard deviation], 38 ± 13 years) and 11 males (age, 34 ± 9 years) were studied. Pre-COX-2 inhibition, resting measures of systolic (S)BP (P = 0.2) and diastolic (D)BP (P = 0.1) were similar between sexes. Post-COX-2 inhibition, resting SBP (P < 0.001) and DBP (P = 0.02) were significantly lower in females than in males. COX-2 inhibition was not associated with changes in arterial parameters by sex (change in DBP: P = 0.54; change in PWV: P = 0.55; females vs males). COX-2 inhibition was associated with increased SBP (P = 0.039 vs pre-COX-2 inhibition), but no change in DBP (P = 0.16) or PWV (P = 0.52) response to AngII challenge in females. Measures did not differ in response to AngII pre- vs post-COX-2 inhibition in males (SBP: P = 0.88; DBP: P = 0.93; PWV: P = 0.97). Conclusions The effects of COX-2 inhibition on arterial function may differ by sex, but further studies are needed. Given the association between nonsteroidal anti-inflammatory drugs (NSAIDs) and cardiovascular risk, increased attention regarding sex-specific pathophysiology is warranted.
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Affiliation(s)
- Chantal L Rytz
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sandra M Dumanski
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Kidney Disease Network, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
| | - Darlene Y Sola
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada
| | - Sofia B Ahmed
- Cumming School of Medicine, University of Calgary, Calgary, Alberta, Canada.,Libin Cardiovascular Institute, University of Calgary, Calgary, Alberta, Canada.,Alberta Kidney Disease Network, Calgary, Alberta, Canada.,O'Brien Institute for Public Health, University of Calgary, Calgary, Alberta, Canada
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17
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Todesco B, Ostuzzi G, Gastaldon C, Papola D, Barbui C. Essential medicines for mental disorders: comparison of 121 national lists with WHO recommendations. Arch Public Health 2023; 81:8. [PMID: 36653880 PMCID: PMC9850500 DOI: 10.1186/s13690-022-01014-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2022] [Accepted: 12/18/2022] [Indexed: 01/19/2023] Open
Abstract
BACKGROUND To compare the medicines for mental disorders included in national essential medicines lists with the World Health Organization (WHO) essential medicines list and assess the extent to which economic status and WHO Region account for the differences. METHODS We searched WHO repository and government sites for national essential medicines lists and we abstracted medicines for mental disorders. We calculated the proportion of WHO essential medicines included, the total number of differences (counting both additions and deletions) between national and WHO model list and the proportion of lists including one second-generation oral antipsychotic plus one new-generation antidepressant. Non-parametric statistics was used to investigate whether these indicators were dependent on economic status and WHO Region. RESULTS Amongst the 121 identified national lists, the total number of medicines for mental disorders ranged from 2 to 63 (median: 18; IQR: 14 to 25). The median proportion of WHO essential medicines for mental disorders included was 86% (IQR: 71-93%), with 16 countries (13%, 95% CI 7.75-20.5%) including all WHO essential medicines, while the median number of differences with the WHO EML was 11 (IQR: 7 to 15). Country economic level was positively associated with both the proportion of WHO essential medicines included (Spearman's rho = 0.417, p < 0.001) and the number of differences (Spearman's rho = 0.345, p < 0.001), implying that countries with higher income level included more WHO essential medicines, but also more additional medicines. Significant differences were observed in relation to WHO Region, with the African and Western Pacific Region showing the lowest proportions of WHO essential medicines, and the European Region showing the highest median number of differences. Overall, 88 national lists (73%, 95% CI 63-80%) included at least one second-generation oral antipsychotic and new-generation antidepressant, with differences by income level and WHO Region. CONCLUSIONS The degree of alignment of national lists with the WHO model list is substantial, but there are considerable differences in relation to economic status and WHO Region. These findings may help decision-makers to identify opportunities to improve national lists, aiming to increase access to essential medicines for mental disorders.
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Affiliation(s)
- Beatrice Todesco
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy ,grid.5611.30000 0004 1763 1124Department of Neurosciences, Biomedicine and Movement Sciences Section of Psychiatry, University of Verona, Verona, Italy
| | - Giovanni Ostuzzi
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Chiara Gastaldon
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Davide Papola
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy
| | - Corrado Barbui
- grid.5611.30000 0004 1763 1124WHO Collaborating Centre for Research and Training in Mental Health and Service Evaluation, Department of Neuroscience, Biomedicine and Movement Sciences, Section of Psychiatry, University of Verona, Verona, Italy ,grid.5611.30000 0004 1763 1124Cochrane Global Mental Health, University of Verona, Verona, Italy
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18
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Khalil AMA, Saleh AM, Abo El-Souad SMS, Mohamed MSM. Plants from a semi-arid environment as a source of phytochemicals against Fusarium crown and foot rot in zucchini. AMB Express 2023; 13:6. [PMID: 36648547 PMCID: PMC9845481 DOI: 10.1186/s13568-023-01515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2022] [Accepted: 01/09/2023] [Indexed: 01/18/2023] Open
Abstract
Fusarium crown and foot rot, caused by F. solani f. sp. cucurbitae, are major fungal diseases affecting zucchini and other cucurbits. Despite the efficacy of synthetic fungicides, their health and environmental hazards have highlighted the urgent need for safer alternatives, such as phytochemical-based biocides. Owing to the upregulation of the plant secondary metabolism under stressful conditions, bioprospecting in harsh environments could reveal ore plants for bioactive metabolites. In this study, thirteen wild plants were collected from their natural habitat in a semiarid environment (Yanbu, Saudi Arabia) and extracted to obtain phenolics rich extracts. Total polyphenols, flavonoids, antioxidant capacities and the antifungal activities of the extracts against a pathogenic isolate of F. solani were assessed. Fusarium solani was isolated from infected zucchini and characterized by scanning electron microscopy. Hierarchical clustering analysis of the phytochemical screening and in vitro bioactivity revealed that Rosmarinus officinalis, Pulicaria crispa, Achillea falcata and Haloxylon salicornicum were the richest in polyphenols and the most powerful against F. solani. Further, the extracts of these four plants significantly decreased the disease incidence in zucchini, where P. crispa was the premier. Interestingly, results of transmission electron microscopy revealed that extract of P. crispa, as a representative of the powerful group, induced ultrastructural disorders in fungal cells. Therefore, this study suggests the use of R. officinalis, P. crispa, A. falcata and H. salicornicum grown in semi-arid environments as ore plants to develop phytochemical-based biocides against Fusarium crown and foot rot.
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Affiliation(s)
- Ahmed M. A. Khalil
- grid.411303.40000 0001 2155 6022Botany and Microbiology Department, Faculty of Science, Al-Azhar University, Cairo, Egypt
| | - Ahmed M. Saleh
- grid.7776.10000 0004 0639 9286Department of Botany and Microbiology, Faculty of Science, Cairo University, Giza, 12613 Egypt
| | - Sayed M. S. Abo El-Souad
- grid.7776.10000 0004 0639 9286Department of Botany and Microbiology, Faculty of Science, Cairo University, Giza, 12613 Egypt
| | - Mahmoud S. M. Mohamed
- grid.7776.10000 0004 0639 9286Department of Botany and Microbiology, Faculty of Science, Cairo University, Giza, 12613 Egypt
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19
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Naicker I, Suleman F, Perumal-Pillay VA. A quantitative comparison of essential cardiovascular medicines from countries in the Southern African Development Community to the WHO model essential medicines list. J Pharm Policy Pract 2022; 15:97. [PMID: 36482421 PMCID: PMC9733348 DOI: 10.1186/s40545-022-00494-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2022] [Accepted: 11/17/2022] [Indexed: 12/13/2022] Open
Abstract
BACKGROUND Globally, cardiovascular disease (CVD) is a leading cause of death and disproportionately affects low- and middle-income countries (LMICs). The WHO Model List of Essential Medicines (WHO EML) is a tool for improving accessibility and availability of medicines. This study compared the 2021 WHO EML CVDs basket of medicines with latest available national essential medicines list (NEMLs) for South Africa and 15 Southern African Development Community (SADC) countries to assess consistency in CVDs medicine listing. METHODS This descriptive, desktop review study compared SADC NEMLs. A comparator list was extracted by combining cardiovascular medicines listed in the 2021 WHO EML for adults and children. SADC country NEMLs were obtained from the WHO Essential Medicines and Health Products Information Portal. Consistency of NEMLs was calculated as a percentage coverage of CVD medicines listed in the 2021 WHO EML. SA hospital and primary health care (PHC) level NEMLs were included as separate formularies. RESULTS The SA hospital level NEML scored 70% consistency with the 2021 WHO EML. Tanzania (84%), Namibia (81%) and Angola (79%) scored the highest consistency. The mean consistency for SADC NEMLs was 66%. The lowest scoring country was Eswatini at 26%. The SA PHC NEML scored 35%. The least listed medicines were beta-blockers, angiotensin receptor blockers (ARBs), clopidogrel (43%) and paediatric formulations (furosemide (21%); digoxin (43%)). Individual antihypertensive medicines were most commonly listed. Botswana and Lesotho were the only countries to list a single pill combination (SPC) for the treatment of hypertension. CONCLUSIONS This comparison indicates that South Africa and most SADC countries are aligned with 2021 WHO EML recommendations. The inclusion of age-appropriate formulations for children as well as ARBs and SPC for the treatment of hypertension may improve patient adherence and cardiovascular outcomes in these countries. More frequent updates to NEMLs should improve consistency. NEMLs were not available for two countries, and these therefore did not form part of this study. Country health expenditure in ranking the consistency of NEMLs was not accounted for. LMICs adopting the essential medicine list strategy should consider imposing minimum consistency thresholds to the WHO EML to improve accessibility and availability of CVD medicines. TRIAL REGISTRATION Not applicable.
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Affiliation(s)
- Ian Naicker
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
| | - Fatima Suleman
- grid.16463.360000 0001 0723 4123College of Health Sciences, University of KwaZulu-Natal, Durban, South Africa
| | - Velisha Ann Perumal-Pillay
- grid.16463.360000 0001 0723 4123Discipline of Pharmaceutical Sciences, University of KwaZulu-Natal, Private Bag X54001, Durban, 4000 South Africa
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20
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Parmar A, Nath S, Bhatia G. Essential substance use disorder medications in Asia Pacific countries: An observational study. Asian J Psychiatr 2022; 78:103276. [PMID: 36244296 DOI: 10.1016/j.ajp.2022.103276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/19/2022] [Revised: 09/25/2022] [Accepted: 09/28/2022] [Indexed: 11/02/2022]
Abstract
AIM To analyze national lists of essential medicines (NLEM) of Asia Pacific countries for inclusion of substance use disorder (SUD) medications. METHODS An observational study was conducted using the most recent versions of NLEM of all 55 Asia Pacific countries till April, 2022. SUD medication details were extracted and analyzed. RESULTS NLEM of included nations contained a median 2 medications for long term SUD management. Sixteen countries had atleast one medication for opioid use disorder and 13 for alcohol use disorder. Four countries had atleast one medication for opioid, alcohol, and tobacco use disorders. CONCLUSION NLEM expansion is needed considering public health burden of SUDs.
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Affiliation(s)
- Arpit Parmar
- Department of Psychiatry, All India Institute of Medical Sciences, Bhubaneswar, India
| | - Santanu Nath
- Department of Psychiatry, All India Institute of Medical Sciences, Deogarh, India
| | - Gayatri Bhatia
- Department of Psychiatry, All India Institute of Medical Sciences, Rajkot, India.
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Denhere K, Dzinamarira T, Tungwarara N, Kampira V, Chitungo I, Mataruka K, Mukwenha S, Musuka G, Murewanhema G. Towards equitable and sustainable availability of blood products in Zimbabwe: An analysis of strengths, weaknesses, opportunities and challenges. Transfus Clin Biol 2022; 29:273-275. [PMID: 35781073 DOI: 10.1016/j.tracli.2022.06.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2022] [Revised: 06/09/2022] [Accepted: 06/23/2022] [Indexed: 10/17/2022]
Abstract
Blood transfusion can be a lifesaving intervention in a number of medical emergencies. To attain sustainable and equitable availability of blood products, it is important to understand the strengths, weaknesses, opportunities, and challenges of the national blood services programme. We, therefore, with this letter to the editor, discuss some of the strengths, weaknesses, opportunities and threats to the Zimbabwean programme since its inception. Despite several strengths and opportunities that the national blood services of Zimbabwe (NBSZ) leverages on, we argue that among other challenges, donor shortages and an upsurge of transfusion transmittable infections in the eligible donor population continue to be the biggest threats to the achievement of the programme objectives. These can be addressed through expanding the blood donor base and the catchment area. Additionally, improving the level of knowledge and attitude towards blood donation in the communities is critical for driving the sustainable and equitable distribution of safe blood products to the population.
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Affiliation(s)
- K Denhere
- University of Western Cape, Cape Town, South Africa
| | - T Dzinamarira
- ICAP at Columbia University, Harare, Zimbabwe; School of Health Systems & Public Health, University of Pretoria, Pretoria 0002, South Africa.
| | - N Tungwarara
- University of South Africa, Pretoria, South Africa
| | - V Kampira
- National TB Reference Laboratory, Bulawayo, Zimbabwe
| | - I Chitungo
- Department of Primary Health Care Sciences, Faculty of Medicine and Health Sciences, University of Zimbabwe, Harare, Zimbabwe
| | - K Mataruka
- Biomedical Research and Training Institute, Harare, Zimbabwe
| | - S Mukwenha
- ICAP at Columbia University, Harare, Zimbabwe
| | - G Musuka
- ICAP at Columbia University, Harare, Zimbabwe
| | - G Murewanhema
- Biomedical Research and Training Institute, Harare, Zimbabwe
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Chen X, Zhang T, Wang H, Feng Z, Jin G, Shao S, Du J. Factors influencing the prescription pattern of essential medicines from the perspectives of general practitioners and patients: a qualitative study in China. BMJ Open 2022; 12:e055091. [PMID: 35545386 PMCID: PMC9096529 DOI: 10.1136/bmjopen-2021-055091] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
OBJECTIVES This qualitative study aimed to explore the factors influencing the prescription patterns of essential medicines (EMs) from the perspectives of general practitioners (GPs) and patients in Beijing, China. DESIGN The qualitative study was conducted using individual in-depth interviews. SETTING This study was conducted from January to August 2020, in community health service centres (CHSCs) across six urban districts of Beijing, China. PARTICIPANTS A total of 17 GPs from 17 CHSCs in 6 urban districts and 22 patients with non-communicable diseases from three CHSCs in the three urban districts of Beijing were recruited using the purposive sampling method and a three-stage sampling strategy, respectively. RESULTS Five major themes were identified among factors influencing the prescription pattern of EMs: (1) efficacy and safety of medicines, (2) prescription recommendations from physicians in tertiary or secondary hospitals, (3) patients' medication preference, (4) financial status of patients and (5) minimum requirement for the prescription of EMs. CONCLUSION The findings of this study contribute to our understanding of the factors influencing the prescription patterns and utilisation of EMs from the perspectives of GPs and patients, respectively. Policymakers should implement policies and measures to promote the National Essential Medicines System in China.
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Affiliation(s)
- Xiaolei Chen
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Tiancheng Zhang
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Huanling Wang
- Department of General Practice, ShuangJing Community Health Service Center, Chaoyang District, Beijing, China
| | - Zhengwen Feng
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Guanghui Jin
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Shuang Shao
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
| | - Juan Du
- School of General Practice and Continuing Education, Capital Medical University, Beijing, China
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Razis E, Kassapian M, Andriakopoulou C, Martei YM, Zurn SJ, Hammad N, Romero Y, Dafni U, Ilbawi AM, Trapani D. Essential medicines list in national cancer control plans: a secondary analysis from a global study. Lancet Oncol 2022; 23:e144-154. [PMID: 35240089 DOI: 10.1016/s1470-2045(21)00706-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2021] [Revised: 11/26/2021] [Accepted: 12/01/2021] [Indexed: 01/19/2023]
Abstract
With the advent of innovative therapeutics for and the rising costs of cancer management, low-income and middle-income countries face increasing challenges to deliver effective and sustainable health care. Understanding of how countries are selecting and prioritising essential cancer interventions is poor, including in the formulation of policies for essential medicines. We did an in-depth subanalysis from a global dataset of national cancer control plans (NCCPs), aiming to identify possible determinants of inclusion of policies related to essential medicines in the NCCP. The results showed poor global comprehensiveness of NCCPs, and substantial deficits in policies for financial hardships due to cancer care, specifically for access to cancer medicines. Specification of budget allocations, policy of protection from catastrophic health expenditure, and national treatment guidelines in the NCCPs contributed to more consistent policies on essential cancer medicines. The bedrock to deliver effective cancer programmes resides in the assurance of comprehensive, consistent, and coherent policy formulation, to orient resource selection and health investments, ultimately delivering equitable health for all.
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Affiliation(s)
- Evangelia Razis
- 3rd Department of Medical Oncology, Hygeia Hospital, Athens, Greece.
| | | | | | - Yehoda M Martei
- Department of Medicine, Division of Hematology-Oncology, University of Pennsylvania, Philadelphia, PA, USA
| | - Shalini Jayasekar Zurn
- Knowledge, Advocacy and Policy, Union for International Cancer Control, Geneva, Switzerland
| | - Nazik Hammad
- Kingston Health Sciences Centre Cancer Centre of Southeastern Ontario at Kingston General Hospital, Kingston, ON, USA
| | - Yannick Romero
- Knowledge, Advocacy and Policy, Union for International Cancer Control, Geneva, Switzerland
| | - Urania Dafni
- Frontier Science Foundation Hellas, Athens, Greece; School of Health Sciences, National and Kapodistrian University of Athens, Athens, Greece
| | - André M Ilbawi
- Department of Non-communicable Diseases, World Health Organization, Geneva, Switzerland
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Abstract
Environmental exposure to active pharmaceutical ingredients (APIs) can have negative effects on the health of ecosystems and humans. While numerous studies have monitored APIs in rivers, these employ different analytical methods, measure different APIs, and have ignored many of the countries of the world. This makes it difficult to quantify the scale of the problem from a global perspective. Furthermore, comparison of the existing data, generated for different studies/regions/continents, is challenging due to the vast differences between the analytical methodologies employed. Here, we present a global-scale study of API pollution in 258 of the world's rivers, representing the environmental influence of 471.4 million people across 137 geographic regions. Samples were obtained from 1,052 locations in 104 countries (representing all continents and 36 countries not previously studied for API contamination) and analyzed for 61 APIs. Highest cumulative API concentrations were observed in sub-Saharan Africa, south Asia, and South America. The most contaminated sites were in low- to middle-income countries and were associated with areas with poor wastewater and waste management infrastructure and pharmaceutical manufacturing. The most frequently detected APIs were carbamazepine, metformin, and caffeine (a compound also arising from lifestyle use), which were detected at over half of the sites monitored. Concentrations of at least one API at 25.7% of the sampling sites were greater than concentrations considered safe for aquatic organisms, or which are of concern in terms of selection for antimicrobial resistance. Therefore, pharmaceutical pollution poses a global threat to environmental and human health, as well as to delivery of the United Nations Sustainable Development Goals.
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Piggott T, Nowak A, Brignardello-Petersen R, Cooke GS, Huttner B, Schünemann HJ, Persaud N, Magrini N, Moja L. Global status of essential medicine selection: a systematic comparison of national essential medicine lists with recommendations by WHO. BMJ Open 2022; 12:e053349. [PMID: 35144950 PMCID: PMC8845216 DOI: 10.1136/bmjopen-2021-053349] [Citation(s) in RCA: 11] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVES Examining the availability of essential medicines is a necessary step to monitor country-level progress towards universal health coverage. We compared the 2017 essential medicine lists (EML) of 137 countries to the WHO Model List to assess differences by drug class and country setting. METHODS We extracted all medicines prioritised at country level from most recently available national EMLs and compared each national EML with the 2017 WHO Model List of Essential Medicines (MLEM) as the reference standard. We assess EMLs by WHO region and for different types of medicine subgroups (eg, cancer, anti-infectives, cardiac, psychiatric and anaesthesia medicines) using within second-level anatomical therapeutic class (ATC) drug classes of the ATC Index. RESULTS We included 406 medicines from WHO's 2017 MLEM to compare to 137 concurrent national EMLs. We found a median of 315 (range from 44 to 983) medicines listed on national EMLs. The global median F1 score was 0.59 (IQR 0.47-0.70, maximum possible score indicating alignment with MLEM is 1). The F1 score was the highest (ie, most similar to MLEM) in the South-East Asia region and the lowest in the European region (ie, most dissimilar to MLEM). The F1 score was highest for stomatological preparations (median: 1.00), gynaecological-anti-infectives and antiseptics (median: 1.00), and medicated dressings (median: 1.00), and lowest for 9 anatomical or pharmacological groups (median: 0.00, eg, treatments for bone diseases, digestive enzymes). CONCLUSIONS Most countries are expected to improve their national health coverage by 2030 offering access to essential medicines, but our results revealed substantial gaps in selection of medicines at the national level compared with those recommended by WHO. It is crucial that governments consider investing in those effective medicines that are now neglected and continue monitoring progress towards essential medicine access as part of universal health coverage.
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Affiliation(s)
- Thomas Piggott
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | | | | | - Graham S Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Benedikt Huttner
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence & Impact, McMaster University, Hamilton, Ontario, Canada
| | - Nav Persaud
- Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
| | | | - Lorenzo Moja
- Department of Health Product Policy and Standards, World Health Organization, Geneva, Switzerland
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Maraj D, Steiner L, Persaud N. Essential tuberculosis medicines and health outcomes in countries with a national essential medicines list. J Clin Tuberc Other Mycobact Dis 2022; 27:100305. [PMID: 35308809 PMCID: PMC8924688 DOI: 10.1016/j.jctube.2022.100305] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/04/2022] Open
Abstract
Background Tuberculosis (TB) remains a major cause of morbidity and mortality globally despite effective treatments. Along with high-quality health services, essential medicines are a key tool in curbing TB related mortality. Examining relationships between listing TB medicines on national essential medicines lists (NEMLs) and population health outcomes related to amenable mortality is one way to assess TB care. Methods In this cross-sectional study of 137 countries, we used linear regression to examine the relationship between the number of TB medicines listed on NEMLs and TB related mortality while controlling for country income, region and TB burden. Results Most countries listed essential TB medicines to treat latent, drug-sensitive and disseminated TB but few listed enough for multi-drug resistant TB (MDR-TB) therapy. The total number of TB medicines listed ranged from 1 to 29 (median: 19, interquartile range: 15 to 22). Over 75% of the variation in health outcomes were explained by the number of TB medicines listed, gross domestic product (GDP) per capita, region and high-burden MDR-TB status. The number of TB medicines listed was not associated with TB mortality. Conclusion Most countries list essential TB treatments and the variation in TB outcomes is explained by other factors such as GDP.
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Bruyn E, Nguyen L, Schutte AE, Murphy A, Perel P, Webster R. Implementing Single-Pill Combination Therapy for Hypertension: A Scoping Review of Key Health System Requirements in 30 Low- and Middle-Income Countries. Glob Heart 2022; 17:6. [PMID: 35174047 PMCID: PMC8796691 DOI: 10.5334/gh.1087] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2021] [Accepted: 12/03/2021] [Indexed: 01/26/2023] Open
Abstract
Objective The World Health Organization (WHO) included single-pill combination (SPC) antihypertensive medications on their 2019 essential medicines list (EML) to encourage uptake and improved hypertension control. We documented key national-level facilitators (SPCs on national EMLs, recommendation for SPCs in national hypertension guidelines and availability of SPCs on the market) supporting uptake of SPCs in the 30 most populous low- and middle-income countries (LMICs). Methods A hierarchical information gathering strategy was used including literature and web searches, the use of organisational databases and personal communications with colleagues to obtain information on (1) whether SPC antihypertensives are on national EMLs, (2) whether SPC antihypertensives are recommended in national hypertension guidelines and (3) whether SPCs are available on the market. Results Eleven of 30 LMICs had all facilitators in place being Egypt, Kenya, Nigeria, Sudan, China, the Philippines, Thailand, Iran, Argentina, Colombia and Mexico. Twenty-six countries had national hypertension guidelines (or similar) in place with SPCs being recommended in 18 of these. Apart from Afghanistan, SPCs were available on the market in all countries. The facilitator least present was the inclusion of SPC antihypertensives on national EMLs at 12 of 29 (Turkey does not have an EML). Conclusion This study demonstrated that many LMICs have made significant progress in their uptake of SPC antihypertensives and several had included SPCs on their EMLs and guidelines prior to their inclusion on the WHO EML. Despite this progress, the uptake of SPC antihypertensives in LMICs could be improved including through their further inclusion on EMLs.
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Affiliation(s)
- Eleanor Bruyn
- School of Population Health, University of New South Wales, Sydney, AU
| | - Long Nguyen
- School of Population Health, University of New South Wales, Sydney, AU
| | - Aletta E. Schutte
- School of Population Health, University of New South Wales, Sydney, AU
- The George Institute for Global Health, University of New South Wales, Sydney, AU
- Hypertension in Africa Research Team, MRC Unit for Hypertension and Cardiovascular Disease, North-West University, Potchefstroom, ZA
| | - Adrianna Murphy
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - Pablo Perel
- Centre for Global Chronic Conditions, London School of Hygiene and Tropical Medicine, London, UK
| | - Ruth Webster
- School of Population Health, University of New South Wales, Sydney, AU
- The George Institute for Global Health, University of New South Wales, Sydney, AU
- Centre for Health Economics Research and Evaluation, University of Technology, Sydney, AU
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28
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Global challenges and policy solutions in breast cancer control. Cancer Treat Rev 2022; 104:102339. [DOI: 10.1016/j.ctrv.2022.102339] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2021] [Revised: 01/12/2022] [Accepted: 01/14/2022] [Indexed: 02/08/2023]
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Mishra P, Sandhu JS. Design Is an Essential Medicine. GLOBAL HEALTH, SCIENCE AND PRACTICE 2021; 9:S195-S208. [PMID: 34845043 PMCID: PMC8628499 DOI: 10.9745/ghsp-d-21-00332] [Citation(s) in RCA: 10] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2021] [Accepted: 09/07/2021] [Indexed: 11/15/2022]
Abstract
We provide an analysis of design in global health through a systematic framework to understand what it is, the value it can add, and how it compares to other common problem-solving approaches in global health. We make the case that design is an essential approach when tackling complex global health challenges.
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Affiliation(s)
| | - Jaspal S Sandhu
- Gobee Group, Oakland, CA, USA
- School of Public Health, University of California, Berkeley, Berkeley, CA, USA
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Kraus R, Yeung RSM, Persaud N. Biologic medicine inclusion in 138 national essential medicines lists. Pediatr Rheumatol Online J 2021; 19:140. [PMID: 34488779 PMCID: PMC8419977 DOI: 10.1186/s12969-021-00608-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/09/2021] [Accepted: 05/31/2021] [Indexed: 11/25/2022] Open
Abstract
BACKGROUND Essential medicines lists (EMLs) are intended to reflect the priority health care needs of populations. We hypothesized that biologic disease-modifying antirheumatic drugs (DMARDs) are underrepresented relative to conventional DMARDs in existing national EMLs. We aimed to survey the extent to which biologic DMARDs are included in EMLs, to determine country characteristics contributing to their inclusion or absence, and to contrast this with conventional DMARD therapies. METHODS We searched 138 national EMLs for 10 conventional and 14 biologic DMARDs used in the treatment of childhood rheumatologic diseases. Via regression modelling, we determined country characteristics accounting for differences in medicine inclusion between national EMLs. RESULTS Eleven countries (7.97%) included all 10 conventional DMARDs, 115 (83.33%) ≥5, and all countries listed at least one. Gross domestic product (GDP) per capita was associated with the total number of conventional DMARDs included (β11.02 [95% CI 0.39, 1.66]; P = 0.00279). Among biologic DMARDs, 3 countries (2.2%) listed ≥10, 15 (10.9%) listed ≥5, and 47 (34.1%) listed at least one. Ninety-one (65.9%) of countries listed no biologic DMARDs. European region (β1 1.30 [95% CI 0.08, 2.52]; P = 0.0367), life expectancy (β1-0.70 [95% CI -1.22, - 0.18]; P = 0.0085), health expenditure per capita (β1 1.83 [95% CI 1.24, 2.42]; P < 0.001), and conventional DMARDs listed (β1 0.70 [95% CI 0.33, 1.07]; P < 0.001) were associated with the total number of biologic DMARDs included. CONCLUSION Biologic DMARDs are excluded from most national EMLs. By comparison, conventional DMARDs are widely included. Countries with higher health spending and longer life expectancy are more likely to list biologics.
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Affiliation(s)
- Raphaël Kraus
- Department of Pediatrics, University of Toronto, Toronto, Canada. .,Division of Rheumatology, Hospital for Sick Children, Toronto, Canada.
| | - Rae S. M. Yeung
- grid.42327.300000 0004 0473 9646Division of Rheumatology, Hospital for Sick Children, Toronto, Canada ,grid.17063.330000 0001 2157 2938Departments of Pediatrics, Immunology and Medical Science, University of Toronto, Toronto, Canada
| | - Nav Persaud
- grid.17063.330000 0001 2157 2938Department of Family and Community Medicine, St. Michael’s Hospital, University of Toronto, Toronto, Canada
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Neumann I, Schünemann HJ, Bero L, Cooke G, Magrini N, Moja L. Global access to affordable direct oral anticoagulants. Bull World Health Organ 2021; 99:653-660. [PMID: 34475602 PMCID: PMC8381095 DOI: 10.2471/blt.20.278473] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2020] [Revised: 04/28/2021] [Accepted: 05/03/2021] [Indexed: 11/27/2022] Open
Abstract
Poor control of cardiovascular disease accounts for a substantial proportion of the disease burden in developing countries, but often essential anticoagulant medicines for preventing strokes and embolisms are not widely available. In 2019, direct oral anticoagulants were added to the World Health Organization’s WHO Model list of essential medicines. The aims of this paper are to summarize the benefits of direct oral anticoagulants for patients with cardiovascular disease and to discuss ways of increasing their usage internationally. Although the cost of direct oral anticoagulants has provoked debate, the affordability of introducing these drugs into clinical practice could be increased by: price negotiation; pooled procurement; competitive tendering; the use of patent pools; and expanded use of generics. In 2017, only 14 of 137 countries that had adopted national essential medicines lists included a direct oral anticoagulant on their lists. This number could increase rapidly if problems with availability and affordability can be tackled. Once the types of patient likely to benefit from direct oral anticoagulants have been clearly defined in clinical practice guidelines, coverage can be more accurately determined and associated costs can be better managed. Government action is required to ensure that direct oral anticoagulants are covered by national budgets because the absence of reimbursement remains an impediment to achieving universal coverage. Tackling cardiovascular disease with the aid of direct oral anticoagulants is an essential component of efforts to achieve the World Health Organization’s target of reducing premature deaths due to noncommunicable disease by 25% by 2025.
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Affiliation(s)
- Ignacio Neumann
- Department of Internal Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile
| | - Holger J Schünemann
- Department of Health Research Methods, Evidence and Impact, McMaster University, Hamilton, Canada
| | - Lisa Bero
- Center for Bioethics and Humanities, University of Colorado Anschutz Medical Campus, Aurora, United States of America
| | - Graham Cooke
- Department of Infectious Diseases, Imperial College London, London, England
| | | | - Lorenzo Moja
- Secretariat of the Model List of Essential Medicines, Department of Essential Health Products and Standards, World Health Organization, Avenue Appia 20, 1211 Geneva 27, Switzerland
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Schneider MT, Chang AY, Crosby SW, Gloyd S, Harle AC, Lim S, Lozano R, Micah AE, Tsakalos G, Su Y, Murray CJL, Dieleman JL. Trends and outcomes in primary health care expenditures in low-income and middle-income countries, 2000-2017. BMJ Glob Health 2021; 6:bmjgh-2021-005798. [PMID: 34385159 PMCID: PMC8362721 DOI: 10.1136/bmjgh-2021-005798] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2021] [Accepted: 07/14/2021] [Indexed: 12/26/2022] Open
Abstract
Introduction As the world responds to COVID-19 and aims for the Sustainable Development Goals, the potential for primary healthcare (PHC) is substantial, although the trends and effectiveness of PHC expenditure are unknown. We estimate PHC expenditure for each low-income and middle-income country between 2000 and 2017 and test which health outputs and outcomes were associated with PHC expenditure. Methods We used three data sources to estimate PHC expenditures: recently published health expenditure estimates for each low-income and middle-income country, which were constructed using 1662 country-reported National Health Accounts; proprietary data from IQVIA to estimate expenditure of prescribed pharmaceuticals for PHC; and household surveys and costing estimates to estimate inpatient vaginal delivery expenditures. We employed regression analyses to measure the association between PHC expenditures and 15 health outcomes and intermediate health outputs. Results PHC expenditures in low-income and middle-income countries increased between 2000 and 2017, from $41 per capita (95% uncertainty interval $33–$49) to $90 ($73–$105). Expenditures for low-income countries plateaued since 2014 at $17 per capita ($15–$19). As national income increased, the proportion of health expenditures on PHC generally decrease; however, the fraction of PHC expenditures spent via ambulatory care providers grew. Increases in the fraction of health expenditures on PHC was associated with lower maternal mortality rate (p value≤0.001), improved coverage of antenatal care visits (p value≤0.001), measles vaccination (p value≤0.001) and an increase in the Health Access and Quality index (p value≤0.05). PHC expenditure was not systematically associated with all-age mortality, communicable and non-communicable disease (NCD) burden. Conclusion PHC expenditures were associated with maternal and child health but were not associated with reduction in health burden for other key causes of disability, such as NCDs. To combat changing disease burdens, policy-makers and health professionals need to adapt primary healthcare to ensure continued impact on emerging health challenges.
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Affiliation(s)
- Matthew T Schneider
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA .,Institute for Disease Modeling, Bellevue, Washington, USA
| | - Angela Y Chang
- Danish Institute for Advanced Study, Copenhagen, Denmark.,Department of Clinical Research, University of Southern Denmark, Odense, Syddanmark, Denmark
| | - Sawyer W Crosby
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Stephen Gloyd
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | - Anton C Harle
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Stephen Lim
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Rafael Lozano
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Angela E Micah
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Golsum Tsakalos
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
| | - Yanfang Su
- Department of Global Health, University of Washington, Seattle, Washington, USA
| | | | - Joseph L Dieleman
- Institute for Health Metrics and Evaluation, Seattle, Washington, USA
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Taglione MS, Persaud N. Assessing variation among the national essential medicines lists of 21 high-income countries: a cross-sectional study. BMJ Open 2021; 11:e045262. [PMID: 34380717 PMCID: PMC8359480 DOI: 10.1136/bmjopen-2020-045262] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVE Essential medicines lists have been created and used globally in countries that range from low-income to high-income status. The aim of this paper is to compare the essential medicines list of high-income countries with each other, the WHO's Model List of Essential Medicines and the lists of countries of other income statuses. DESIGN High-income countries were defined by World Bank classification. High-income essential medicines lists were assessed for medicine inclusion and were compared with the subset of high-income countries, the WHO's Model List and 137 national essential medicines lists. Medicine lists were obtained from the Global Essential Medicines database. Countries were subdivided by income status, and the groups' most common medicines were compared. Select medicines and medicine classes were assessed for inclusion among high-income country lists. RESULTS The 21 high-income countries identified were most like each other when compared with other lists. They were more like upper middle-income countries and least like low-income countries. There was significant variability in the number of medicines on each list. Less than half (48%) of high-income countries included a newer diabetes medicines in their list. Most countries (71%) included naloxone while every country including at least one opioid medicine. More than half of the lists (52%) included a medicine that has been globally withdrawn or banned. CONCLUSION Essential medicines lists of high-income countries are similar to each other, but significant variations in essential medicine list composition and specifically the number of medications included were noted. Effective medicines were left off several countries' lists, and globally recalled medicines were included on over half the lists. Comparing the essential medicines lists of countries within the same income status category can provide a useful subset of lists for policymakers and essential medicine list creators to use when creating or maintaining their lists.
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Affiliation(s)
- Michael Sergio Taglione
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Department of Family and Community Medicine, North York General Hospital, Toronto, Ontario, Canada
| | - Nav Persaud
- Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
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Challenges in the Implementation of Chronic Obstructive Pulmonary Disease Guidelines in Low- and Middle-Income Countries: An Official American Thoracic Society Workshop Report. Ann Am Thorac Soc 2021; 18:1269-1277. [PMID: 34328399 PMCID: PMC8513652 DOI: 10.1513/annalsats.202103-284st] [Citation(s) in RCA: 22] [Impact Index Per Article: 7.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
There is a substantial burden of chronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), in low- and middle-income countries (LMICs). LMICs have particular challenges in delivering cost-effective prevention, diagnosis, and management of COPD. Optimal care can be supported by effective implementation of guidelines. This American Thoracic Society workshop considered challenges to implementation of COPD guidelines in LMICs. We make 10 specific recommendations: 1) relevant organizations should provide LMIC-specific COPD management guidance; 2) patient and professional organizations must persuade policy-makers of the importance of lung function testing programs in LMICs; 3) healthcare education and training should emphasize the early-life origins of COPD; 4) urgent action is required by governments to reduce airborne exposures, including exposures to tobacco smoke and indoor and outdoor air pollution; 5) guidance for COPD in LMICs should explicitly link across Essential Medicine Lists and the World Health Organization package of essential noncommunicable disease interventions for primary health care in low-resource settings and should consider availability, affordability, sustainability, and cost-effective use of medicines; 6) the pharmaceutical industry should work to make effective COPD and tobacco-dependence medicines globally accessible and affordable; 7) implementation of locally adapted, cost-effective pulmonary rehabilitation programs should be an international priority; 8) the World Health Organization Global Action Plan for the Prevention and Control of Noncommunicable Diseases should specify how improvements in respiratory health will be achieved; 9) research funders should increase the proportion of funding allocated to COPD in LMICs; and 10) the respiratory community should leverage the skills and enthusiasm of earlier-career clinicians and researchers to improve global respiratory health.
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Adekoya I, Maraj D, Steiner L, Yaphe H, Moja L, Magrini N, Cooke G, Loeb M, Persaud N. Comparison of antibiotics included in national essential medicines lists of 138 countries using the WHO Access, Watch, Reserve (AWaRe) classification: a cross-sectional study. THE LANCET. INFECTIOUS DISEASES 2021; 21:1429-1440. [PMID: 34332706 DOI: 10.1016/s1473-3099(20)30854-9] [Citation(s) in RCA: 13] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/20/2020] [Revised: 09/25/2020] [Accepted: 10/21/2020] [Indexed: 01/03/2023]
Abstract
BACKGROUND The WHO Model List of Essential Medicines classified antibiotics into Access, Watch, and Reserve (AWaRe) categories for the treatment of 31 priority bacterial infections as a tool to facilitate antibiotic stewardship and optimal use. We compared the listing of antibiotics on national essential medicines lists (NEMLs) to those in the 2019 WHO Model List and the AWaRe classification database to determine the degree to which NEMLs are in alignment with the AWaRe classification framework recommended by WHO. METHODS In this cross-sectional study, we obtained up-to-date (data after 2017) NEMLs from our Global Essential Medicines (GEM) database, WHO online resources, and individual countries' websites. From the 2019 WHO Model List we extracted, as a reference standard, a list of 37 antibiotics (44 unique antibiotics after accounting for combination drugs or therapeutically equivalent drugs as specified by WHO) that were considered essential in treating 31 of the most common and severe clinical infectious syndromes (priority infections). From the WHO AWaRe Classification Database, which contains commonly used antibiotics globally, we extracted a list of 122 AWaRe antibiotics listed by at least one country in the GEM database. We then assessed individual countries' NEMLs for listing of the 44 essential and 122 commonly used antibiotics, overall and according to AWaRe classification group. We also evaluated and summarised the listing of both first-choice and second-choice treatments for the 31 priority infections. A total coverage score was calculated for each country by assigning a treatment score of 0-3 for each priority infection on the basis of whether first-choice and second-choice treatments, according to the 2019 WHO Model List, were included in the country's NEML. Coverage scores were then compared against the score of the 2019 WHO Model List and across World Bank income groups and WHO regions. FINDINGS As of July 7, 2020, we had up-to-date NEMLs for 138 countries. Of the 44 unique essential antibiotics, 24 were Access, 15 were Watch, and five were Reserve. The median number of total essential antibiotics listed across the 138 NEMLs was 26 (IQR 21-32). 102 (74%) countries listed at least 22 (50%) of the 44 essential antibiotics. The median number of total AWaRe antibiotics listed by the 138 countries was 35 (IQR 29-46), of Access antibiotics was 18 (16-21), of Watch antibiotics was 16 (11-22), and of Reserve antibiotics was one (0-2). 56 (41%) countries did not list any essential Reserve antibiotics. 131 (95%) countries had coverage scores of at least 60, equivalent to at least 75% of the score of the 2019 WHO Model List, which was 80. Nine (7%) countries listed fewer than 12 of 24 essential Access antibiotics, and seven (5%) did not list sufficient first-choice and second-choice treatments for priority infections (ie, they had coverage scores lower than 60). Of the 31 priority infections, acute neonatal meningitis and high-risk febrile neutropenia did not have enough listed treatments, with 82 (59%) countries listing no treatment for acute neonatal meningitis and 84 (61%) countries listing only a first-choice treatment, only a second-choice treatment, or no treatment for high-risk febrile neutropenia. Coverage scores differed between countries on the basis of World Bank income groups (p=0·025). INTERPRETATION Our findings highlight potential changes to the antibiotics included in NEMLs that would increase adherence to international guidance aimed at effectively treating infectious diseases while addressing antimicrobial resistance. FUNDING Canadian Institutes of Health Research and Ontario Strategy for Patient Oriented Research Support Unit.
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Affiliation(s)
- Itunuoluwa Adekoya
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Darshanand Maraj
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Liane Steiner
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Hannah Yaphe
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Lorenzo Moja
- Department of Essential Medicines and Health Products, WHO, Geneva, Switzerland
| | - Nicola Magrini
- Department of Essential Medicines and Health Products, WHO, Geneva, Switzerland
| | - Graham Cooke
- Department of Infectious Disease, Imperial College London, London, UK
| | - Mark Loeb
- Department of Pathology and Molecular Medicine, McMaster University Faculty of Health Sciences, Hamilton, ON, Canada
| | - Nav Persaud
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada; Department of Family and Community Medicine, University of Toronto Faculty of Medicine, Toronto, ON, Canada.
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Oo TH, Tianviwat S, Thitasomakul S. Oral Health System in Myanmar: A Review. J Int Soc Prev Community Dent 2021; 11:231-241. [PMID: 34268184 PMCID: PMC8257009 DOI: 10.4103/jispcd.jispcd_438_20] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2020] [Revised: 01/05/2020] [Accepted: 03/03/2021] [Indexed: 11/23/2022] Open
Abstract
Objectives: The study aims at reviewing Myanmar’s current situation to consider an improved oral health system and at promoting the oral health status of the Myanmar population. Materials and Methods: This review was conducted using the World Health Organization’s (WHO’s) six building blocks of the health system: oral health-care service delivery, dental workforce, oral health information system, essential medicine, health financing, and leadership and governance. The review was established on scientific articles and documents and information from reliable government and nongovernment organizations’ websites. Results: According to the National Oral Health Survey (2016–2017), the prevalence rate of untreated caries in six-year-old Myanmar children (84.1%), and in the 35–44 and 65–74 age group (above 40%) is high, which reflects a low utilization of oral health-care services. The dentist to population ratio is approximately 1:16,000: There are around 5,000 dentists and 400 trained dental nurses in Myanmar, and only about 1,000 dentists serve in government sectors. The inequalities in dental health care are compounded by a limited dental workforce and inequality of dentists between the public and private sectors in Myanmar. In the last National Health Plan (NHP, 2006–2011), the Myanmar government’s funding for required dental equipment and materials in each dental unit (around 5726 USD) has been considered inadequate. The current expenditure is not transparent. The other challenges are an insufficient supply of dental materials and instruments to all public dental sectors and a lack of oral health-care infrastructure. Conclusions: Such findings suggest a pressing need to address the effective oral health-care system and decree the specific goals for the Myanmar population’s oral health.
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Affiliation(s)
- Tin Htet Oo
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand.,Department of Medical Service, Ministry of Health and Sports (MOHS), Naypyitaw, Myanmar
| | - Sukanya Tianviwat
- Evidence-Based Dentistry for Oral Health Care and Promotion Research Unit, Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand
| | - Songchai Thitasomakul
- Department of Preventive Dentistry, Faculty of Dentistry, Prince of Songkla University, Hatyai, Songkhla, Thailand
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Benipal S, Budhram DR, Bilimoria K, Woods H, Wang R, Persaud N. Essential tobacco dependence medicines in 137 countries. Addiction 2021; 116:1606-1609. [PMID: 33022824 DOI: 10.1111/add.15282] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/11/2020] [Revised: 09/15/2020] [Accepted: 09/25/2020] [Indexed: 11/29/2022]
Abstract
AIMS To use a database of national essential medicine lists to determine how many include the three tobacco dependence medicines: nicotine replacement therapy, varenicline and bupropion. METHODS Retrospective observational study using national essential medicine lists for 137 countries. RESULTS Of the 137 countries, 34 listed at least one of the three tobacco dependence medicines included in this analysis. Bupropion was listed by 23 countries, nicotine replacement therapy by 17 countries and varenicline by eight countries. CONCLUSIONS Tobacco dependence medicines do not appear on the essential medicines lists of most countries.
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Affiliation(s)
- Simran Benipal
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Dalton R Budhram
- Department of Medicine, Queen's University, Kingston, ON, Canada
| | - Krish Bilimoria
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada
| | - Hannah Woods
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada
| | - Nav Persaud
- Faculty of Medicine, University of Toronto, Toronto, ON, Canada.,MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, ON, Canada.,Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada
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Budhram D, Benipal S, Bilimoria K, Maraj D, Wang R, Persaud N. Essential diabetes medicines and health outcomes in 127 countries. Diabetes Obes Metab 2021; 23:1121-1128. [PMID: 33417268 DOI: 10.1111/dom.14316] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Revised: 12/18/2020] [Accepted: 01/04/2021] [Indexed: 01/04/2023]
Abstract
AIM Diabetes is the ninth leading cause of death. Improving access to diabetes medicines may decrease mortality. Diabetes medicines on national essential medicines lists (NEMLs) vary considerably. We examine the association between diabetes population health outcomes relating to mortality and the listing of diabetes medicines on national essential medicine lists for 127 countries. MATERIALS AND METHODS We conducted a cross-sectional study. We determined the number of diabetes medicines on NEMLs and used multiple linear regression to analyse the association between diabetes health outcomes and the number of medicines on NEMLs. We used linear regression to assess the association between diabetes health outcomes and the listing of or not listing of medicines that were listed by 25-75% of countries. Diabetes prevalence, gross domestic product (GDP) per capita and mean expenditure per person with diabetes were controlled for in all analyses. RESULTS The total number of diabetes medicines listed on NEMLs ranged from 0 to 16 (median: 4; interquartile range: 3-6). Diabetes health outcome scores were associated with the number of diabetes medicines on NEMLs [1.3-point increase (95% confidence interval, 95% CI 0.5-2.1) for every additional medicine on NEMLs; P = .002] and GDP per capita [19.5-point increase (95% CI 5.4-33.6) for every 10-fold increase in GDP; P = .003]. Diabetes expenditure was not associated with health outcome scores (P = .23). Increases in diabetes health outcomes score were associated with the listing of glimepiride (7.9-point increase, 95% CI 2.3-13.5, P = .006) and glipizide (5.8-point increase, 95% CI 0.03-11.6, P = .049) on NEMLs. CONCLUSIONS Listing of diabetes medicines on NEMLs has the potential to improve population health outcomes related to mortality in countries with diverse incomes and diabetes prevalence without necessarily increasing diabetes health expenditure.
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Affiliation(s)
- Dalton Budhram
- Department of Medicine, Queen's University, Kingston, Ontario, Canada
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Simran Benipal
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Krish Bilimoria
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
- Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
| | - Darshanand Maraj
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Ri Wang
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
| | - Nav Persaud
- MAP Centre for Urban Health Solutions, St Michael's Hospital, Toronto, Ontario, Canada
- Department of Family and Community Medicine, University of Toronto, Toronto, Ontario, Canada
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Machado FLDS, Dos Santos DMDSS, Lopes LC. Strategies to Approach Medicines Litigation: An Action Research Study in Brazil. Front Pharmacol 2021; 12:612426. [PMID: 33967753 PMCID: PMC8100662 DOI: 10.3389/fphar.2021.612426] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Accepted: 02/16/2021] [Indexed: 11/15/2022] Open
Abstract
Background: In the last decades, litigation has been increasingly used to access medicines in Brazil. This phenomenon has led to the development of diverse strategies to reduce its negative impact on the organization of pharmaceutical services. In spite of that, managers still face difficulties dealing with lawsuits. Objective: This study aims to report the planning and implementation of strategies to approach medicines litigation in a municipality located in the southeast region of Brazil. Methods: Mixed methods were employed through an action research cycle. A network coordination team included researchers from university and municipal managers. The scenario analysis comprised the characterization of pharmaceutical services and the profile of medicines lawsuits. Afterward, strategies were planned to deal with the central problem identified. The action plan involved educational outreach visits and distribution of printed materials for health professionals, evaluated through opinion survey. Group conversations were conducted with the users of the public health system, followed by thematic analysis of reports. Results: The characterization of pharmaceutical services in the municipality revealed that treatments supplied were in accordance with the National Medicines Policy. In addition, a sector was implemented to attend demands for non-incorporated medicines. In spite of the services available, the characterization of lawsuits indicated that the main claimants were users of the public health system, requiring non-incorporated medicines, with therapeutic alternatives available. Thus, educational outreach visits were held in 14 health units (23 physicians in total). Everyone who answered the evaluation declared that they were very satisfied with the approach. Group conversations with the users of the health system reached 227 participants in total. In regard to users’ perception about pharmaceutical services, thematic analysis of reports identified three main categories including aspects related to medicines provided, users assisted, and quality of service. Conclusion: The study described the first cycle of an action research project to develop strategies to approach medicines litigation at the municipal level. The application of educational outreach visits for health professionals and group conversations with health system users is a promising approach to improve access to information about pharmaceutical services in Brazil.
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Affiliation(s)
| | | | - Luciane Cruz Lopes
- Pharmaceutical Sciences Graduate Course, University of Sorocaba, UNISO, Sorocaba, Brazil
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Steiner L, Fraser S, Maraj D, Persaud N. Associations between essential medicines and health outcomes for cardiovascular disease. BMC Cardiovasc Disord 2021; 21:151. [PMID: 33765933 PMCID: PMC7992928 DOI: 10.1186/s12872-021-01955-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/13/2020] [Accepted: 03/14/2021] [Indexed: 11/22/2022] Open
Abstract
BACKGROUND National essential medicines lists are used to guide medicine reimbursement and public sector medicine procurement for many countries therefore medicine listings may impact health outcomes. METHODS Countries' national essential medicines lists were scored on whether they listed proven medicines for ischemic heart disease, cerebrovascular disease and hypertensive heart disease. In this cross sectional study linear regression was used to measure the association between countries' medicine coverage scores and healthcare access and quality scores. RESULTS There was an association between healthcare access and quality scores and health expenditure for ischemic heart disease (p ≤ 0.001), cerebrovascular disease (p ≤ 0.001) and hypertensive heart disease (p ≤ 0.001). However, there was no association between medicine coverage scores and healthcare access and quality scores for ischemic heart disease (p = 0.252), cerebrovascular disease (p = 0.194) and hypertensive heart disease (p = 0.209) when country characteristics were accounted for. CONCLUSIONS Listing more medicines on national essential medicines lists may only be one factor in reducing mortality from cardiovascular disease and improving healthcare access and quality scores.
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Affiliation(s)
- Liane Steiner
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | | | - Darshanand Maraj
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada
| | - Nav Persaud
- MAP Centre for Urban Health Solutions, St. Michael's Hospital, Toronto, ON, Canada.
- Department of Family and Community Medicine, University of Toronto, Toronto, ON, Canada.
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Vaiserman A, Koliada A, Lushchak O, Castillo MJ. Repurposing drugs to fight aging: The difficult path from bench to bedside. Med Res Rev 2020; 41:1676-1700. [PMID: 33314257 DOI: 10.1002/med.21773] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/20/2020] [Revised: 11/15/2020] [Accepted: 12/02/2020] [Indexed: 12/23/2022]
Abstract
The steady rise in life expectancy occurred across all developed countries during the last century. This demographic trend is, however, not accompanied by the same healthspan extension. This is since aging is the main risk factor for all age-associated pathological conditions. Therefore, slowing the rate of aging is suggested to be more efficient in preventing or delaying age-related diseases than treat them one by one, which is the common approach in a current pharmacological disease-oriented paradigm. To date, a variety of medications designed to treat particular pathological conditions have been shown to exhibit pro-longevity effects in different experimental models. Among them, there are many commonly used prescription and over-the-counter pharmaceuticals such as metformin, rapamycin, aspirin, statins, melatonin, vitamin antioxidants, etc. All of them are being increasingly investigated in preclinical and clinical trials with the aim of determine whether they have potential for extension of human healthspan. The results from these trials are frequently inconclusive and fall short of initial expectations, suggesting that innovative research ideas and additional translational steps are required to overcome obstacles for implementation of such approaches in clinical practice. In this review, recent advances and challenges in the field of repurposing widely used conventional pharmaceuticals to target the aging process are summarized and discussed.
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Affiliation(s)
| | | | - Oleh Lushchak
- Department of Biochemistry and Biotechnology, Vasyl Stefanyk Precarpathian National University, Ivano-Frankivsk, Ukraine
| | - Manuel J Castillo
- Department of Medical Physiology, School of Medicine, University of Granada, Granada, Spain
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Firth A, Prathapan P. Broad-spectrum therapeutics: A new antimicrobial class. CURRENT RESEARCH IN PHARMACOLOGY AND DRUG DISCOVERY 2020; 2:100011. [PMID: 34870144 PMCID: PMC8035643 DOI: 10.1016/j.crphar.2020.100011] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2020] [Revised: 11/30/2020] [Accepted: 12/03/2020] [Indexed: 01/29/2023] Open
Abstract
There are currently no emergency treatments for pandemics, yet drug repositioning has emerged as the foremost treatment development strategy for COVID-19, with an aim to identify successful antiviral therapeutics from safe, non-antiviral candidates. These therapeutics include antibiotics such as azithromycin and the antiparasitic nitazoxanide, both of which exhibit antiviral activity. Broad-spectrum therapeutics (BSTs) are a class of antimicrobials active against multiple pathogen types. Establishment of a developmental framework for BSTs will markedly improve global preparedness for future health emergencies.
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Affiliation(s)
- Anton Firth
- New Biochemistry, University of Oxford, South Parks Road, Oxford, OX1 3QU, UK
| | - Praveen Prathapan
- New Biochemistry, University of Oxford, South Parks Road, Oxford, OX1 3QU, UK
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Richards GC, Aronson JK, Heneghan C, Mahtani KR, Koshiaris C, Persaud N. Relation between opioid consumption and inclusion of opioids in 137 national essential medicines lists. BMJ Glob Health 2020; 5:e003563. [PMID: 33173012 PMCID: PMC7656944 DOI: 10.1136/bmjgh-2020-003563] [Citation(s) in RCA: 15] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2020] [Revised: 09/09/2020] [Accepted: 10/06/2020] [Indexed: 01/07/2023] Open
Abstract
INTRODUCTION Opioids are deemed essential medicines by the World Health Organization (WHO). However, many countries have inadequate access to them. Whether including opioids in national essential medicines lists (EMLs) influences national opioid consumption has not been evaluated. METHODS We conducted a cross-sectional study to determine whether the listing of opioids in national EMLs was associated with consumption. We quantified the numbers and types of all opioids included in 137 national EMLs, for comparison with opioids in the WHO's Model List of Essential Medicines. Using the International Narcotics Control Board (INCB) consumption statistics for 2015-2017, we assessed the relation between annual mean opioid consumption (mg/person) and the numbers of opioids included in EMLs, controlling for region, population, healthcare expenditure, life expectancy, gross domestic product, human development and corruption. RESULTS Five opioids were included in the 20th edition of the WHO's Model List of Essential Medicines: codeine, fentanyl, loperamide, methadone and morphine. On average, countries' lists included significantly (p<0.05) more opioids than the WHO's Model List. However, there were wide variations in the numbers (median 6 opioids; IQR: 5-9) and types (n=33) of opioids included in national EMLs. Morphine (95%), fentanyl (83%) and codeine (69%) were the most commonly included opioids. Most national EMLs were out of date (median publication date: 2011, IQR: 2009-2013). After adjusting for country characteristics, there was no relation between mean opioid consumption and the number of opioids in EMLs. CONCLUSIONS Including opioids in national EMLs was not associated with consumption. National EMLs should be regularly updated to reflect the availability of opioids and the populations' needs for managing pain.
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Affiliation(s)
- Georgia C Richards
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Jeffrey K Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Kamal R Mahtani
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Constantinos Koshiaris
- Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, Oxfordshire, UK
| | - Nav Persaud
- Department of Family and Community Medicine, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada
- Centre for Urban Health Solutions, Department of Family and Community Medicine, St Michael's Hospital, Toronto, Ontario, Canada
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Di Cesare M, Jarvis JD, Scarlatescu O, Leng X, Zaidel EJ, Burrone E, Eiselé JL, Prabhakaran D, Sliwa K. NOACs Added to WHO's Essential Medicines List: Recommendations for Future Policy Actions. Glob Heart 2020; 15:67. [PMID: 33150132 PMCID: PMC7546116 DOI: 10.5334/gh.774] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2020] [Accepted: 09/04/2020] [Indexed: 01/13/2023] Open
Abstract
The introduction of non-vitamin K antagonists oral anticoagulants, a class of medicines which includes dabigatran, apixaban, edoxaban and rivaroxaban, has resulted in improvements in the safety and efficacy of non valvular atrial fibrillation treatment for stroke prevention, with significant reductions in stroke, intracranial haemorrhage, and mortality. For these reasons, a team of World Heart Federation Emerging Leaders led efforts to add non-vitamin K antagonists oral anticoagulants to the World Health Organization's Model List of Essential Medicines in 2019. Following the inclusion of this class of medicines in the Essential Medicines List, this editorial proposes several recommendations to improve the accessibility, affordability and acceptability of non-vitamin K oral anticoagulants, especially in low- and middle-income settings, in order to successfully manage non-valvular atrial fibrillation and to lower the risk of stroke.
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Affiliation(s)
| | | | | | - Xinyi Leng
- The Chinese University of Hong Kong, Shatin, HK
| | - Ezequiel J. Zaidel
- Cardiology Department, Sanatorio Güemes, and the University of Buenos Aires, Buenos Aires, AR
| | | | | | - Dorairaj Prabhakaran
- London School of Hygiene and Tropical Medicine, London, GB
- World Heart Federation, Geneva, CH
- Public Health Foundation of India, Gurgaon, IN
| | - Karen Sliwa
- World Heart Federation, Geneva, CH
- Hatter Institute for Cardiovascular Research in Africa, University of Cape Town, ZA
- CHI, Faculty of Health Sciences, University of Cape Town, ZA
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Duffin J. An activist history of drug shortages and its silos. Lancet 2020; 396:750-751. [PMID: 32919502 DOI: 10.1016/s0140-6736(20)31876-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Aronson JK, Green AR. Me-too pharmaceutical products: History, definitions, examples, and relevance to drug shortages and essential medicines lists. Br J Clin Pharmacol 2020; 86:2114-2122. [PMID: 32358800 PMCID: PMC7576625 DOI: 10.1111/bcp.14327] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2020] [Revised: 04/20/2020] [Accepted: 04/21/2020] [Indexed: 12/22/2022] Open
Abstract
We define a me‐too drug as a pharmacologically active compound that is structurally related to a first‐in‐class compound, regarded as belonging to the same therapeutic class as the original compound, and used for the same therapeutic purposes, but which may differ in some respects, such as specificity of pharmacological action, adverse reactions profile, or drug–drug interactions. We also offer definitions of related terms, including follow‐on drug and first‐in‐class. The therapeutic advantages of me‐too drugs may include improved target specificity, reduced risks of off‐target adverse reactions and drug–drug interactions, increased chance of benefit in some patients, and improved drug delivery and pharmacokinetics. Me‐too drugs can also demonstrate incremental innovation. Their availability may help in coping with drug shortages. However, they may occasionally cause unexpected adverse reactions that are not class effects. Tricyclic antidepressants, β‐blockers, and statins illustrate the diversity of me‐too drugs. Earlier compounds may be as effective as later ones, or more so. Tricyclic antidepressants have similar chemical structures, and compounds introduced after the first‐in‐class compound (imipramine) mostly offered little in the way of innovative features, but continue to be prescribed. In contrast, me‐too β‐blockers introduced after the first‐in‐class compound, pronethalol, have diverse structures and display several innovative features. Stereoisomers and biosimilars/biobetters provide special examples of me‐too drugs. Although many me‐too drugs offer no significant advantages over their predecessors, over 60% of the drugs listed on the World Health Organization's essential list are me‐toos. Different countries may choose different me‐too drugs when constructing essential medicines lists, partly explaining transnational differences between them.
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Affiliation(s)
- Jeffrey K Aronson
- Centre for Evidence Based Medicine, Nuffield Department of Primary Care Health Sciences, Radcliffe Observatory Quarter, Oxford, UK
| | - A Richard Green
- School of Life Sciences, Queen's Medical Centre, University of Nottingham, Nottingham, UK
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Husain MJ, Datta BK, Kostova D, Joseph KT, Asma S, Richter P, Jaffe MG, Kishore SP. Access to Cardiovascular Disease and Hypertension Medicines in Developing Countries: An Analysis of Essential Medicine Lists, Price, Availability, and Affordability. J Am Heart Assoc 2020; 9:e015302. [PMID: 32338557 PMCID: PMC7428558 DOI: 10.1161/jaha.119.015302] [Citation(s) in RCA: 42] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
Background Access to medicines is important for long-term care of cardiovascular diseases and hypertension. This study provides a cross-country assessment of availability, prices, and affordability of cardiovascular disease and hypertension medicines to identify areas for improvement in access to medication treatment. Methods and Results We used the World Health Organization online repository of national essential medicines lists (EMLs) for 53 countries to transcribe the information on the inclusion of 12 cardiovascular disease/hypertension medications within each country's essential medicines list. Data on availability, price, and affordability were obtained from 84 surveys in 59 countries that used the World Health Organization's Health Action International survey methodology. We summarized and compared the indicators across lowest-price generic and originator brand medicines in the public and private sectors and by country income groups. The average availability of the select medications was 54% in low- and lower-middle-income countries and 60% in high- and upper-middle-income countries, and was higher for generic (61%) than brand medicines (41%). The average patient median price ratio was 80.3 for brand and 16.7 for generic medicines and was higher for patients in low- and lower-middle-income countries compared with high- and upper-middle-income countries across all medicine categories. The costs of 1 month's antihypertensive medications were, on average, 6.0 days' wage for brand medicine and 1.8 days' wage for generics. Affordability was lower in low- and lower-middle-income countries than high- and upper-middle-income countries for both brand and generic medications. Conclusions The availability and accessibility of pharmaceuticals is an ongoing challenge for health systems. Low availability and high costs are major barriers to the use of and adherence to essential cardiovascular disease and antihypertensive medications worldwide, particularly in low- and lower-middle-income countries.
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Affiliation(s)
- Muhammad Jami Husain
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Biplab Kumar Datta
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Deliana Kostova
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Kristy T Joseph
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Samira Asma
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Patricia Richter
- Global Noncommunicable Diseases Branch Division of Global Health Protection Center for Global Health Centers for Disease Control and Prevention Atlanta GA
| | - Marc G Jaffe
- Resolve to Save Lives, an Initiative of Vital Strategies New York NY.,Department of Endocrinology The Permanente Medical Group San Francisco CA
| | - Sandeep P Kishore
- Department of Health System Design & Global Health and Department of Medicine Icahn School of Medicine at Mount Sinai Health System New York USA.,Brigham & Women's Hospital Boston MA
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48
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Steiner L, Maraj D, Woods H, Jarvis J, Yaphe H, Adekoya I, Bali A, Persaud N. A comparison of national essential medicines lists in the Americas. Rev Panam Salud Publica 2020; 44:e5. [PMID: 31998375 PMCID: PMC6984406 DOI: 10.26633/rpsp.2020.5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2019] [Accepted: 10/07/2019] [Indexed: 12/02/2022] Open
Abstract
Objectives. To compare national essential medicines lists (NEMLs) from countries in the Region of the Americas and to identify potential opportunities for improving those lists. Methods. In June of 2017, NEMLs from 31 countries in the Americas were abstracted from documents included in a World Health Organization (WHO) repository. The lists from the Americas were compared to each other and to NEMLs from outside of the Americas, as well as with the WHO Model List of Essential Medicines, 20th edition (“WHO Model List”) and the list of the Pan American Health Organization (PAHO) Regional Revolving Fund for Strategic Public Health Supplies (“Strategic Fund”). Results. The number of differences between the NEMLs from the Americas and the WHO Model List were similar within those countries (median: 295; interquartile range (IQR): 265 to 347). The NEMLs from the Americas were generally similar to each other. While the NEMLs from the Americas coincided well with the Strategic Fund list, some medicines were not included on any of those NEMLs. All the NEMLs in the Americas included some medicines that were withdrawn due to adverse effects by a national regulatory body (median: 8 withdrawn medicines per NEML; IQR: 4 to 12). Conclusions. The NEMLs in the Americas were fairly similar to each other and to the WHO Model List and the Strategic Fund list. However, some areas of treatment and some specific medicines were identified that the countries should reassess when revising their NEMLs.
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Affiliation(s)
- Liane Steiner
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Darshanand Maraj
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Woods
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Jordan Jarvis
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Hannah Yaphe
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Itunu Adekoya
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Anjli Bali
- MAP Centre for Urban Health Solution St. Michael's Hospital TorontoOntario Canada MAP Centre for Urban Health Solution, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Nav Persaud
- Department of Family and Community Medicine St. Michael's Hospital and the University of Toronto TorontoOntario Canada Department of Family and Community Medicine, St. Michael's Hospital and the University of Toronto, Toronto, Ontario, Canada
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49
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McDonell J, Costello K, Laurson-Doube J, Rijke N, Giovannoni G, Banwell B, Baneke P. World Health Organization Essential Medicines List: Multiple sclerosis disease-modifying therapies application. Mult Scler 2020; 26:153-158. [DOI: 10.1177/1352458519898340] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
Introduction: The World Health Organization (WHO) publishes a biennial Essential Medicines List (EML) to assist governments in low-resource settings to prioritize their spending on medicines. Currently, no medicines on the EML have a multiple sclerosis (MS) indication. Multiple Sclerosis International Federation (MSIF) prepared an application for inclusion of MS disease-modifying therapies (DMTs) for the 2019 EML together with the regional Committees for Treatment and Research in Multiple Sclerosis (TRIMS) and the World Federation of Neurology. Rationale: The MSIF taskforce categorized 15 DMTs according to their efficacy and risk profiles to ensure the ability to treat as many different clinical scenarios as possible. Three DMTs were selected: glatiramer acetate, fingolimod, and ocrelizumab. Outcome: The WHO Expert Committee did not recommend the addition of any of the DMTs to the EML. They acknowledged the public health burden of MS, the need for effective and affordable MS medications, and the high volume of letters received in support of the application but requested a revised application. Discussion: Despite the negative outcome, the repeated recognition of MS as a global public health burden is sending a powerful message to governments globally that a range of affordable and good quality medications need to be available to health systems and people affected by MS.
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Affiliation(s)
| | | | | | - Nick Rijke
- Multiple Sclerosis International Federation, London, UK
| | - Gavin Giovannoni
- Blizard Institute, Queen Mary University of London, Barts and The London School of Medicine, London, UK
| | - Brenda Banwell
- Department of Pediatric Neurology, Children’s Hospital of Philadelphia, Philadelphia, PA, USA
| | - Peer Baneke
- Multiple Sclerosis International Federation, London, UK
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50
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Charles O, Onakpoya I, Benipal S, Woods H, Bali A, Aronson JK, Heneghan C, Persaud N. Withdrawn medicines included in the essential medicines lists of 136 countries. PLoS One 2019; 14:e0225429. [PMID: 31791048 PMCID: PMC6887519 DOI: 10.1371/journal.pone.0225429] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2019] [Accepted: 11/04/2019] [Indexed: 01/01/2023] Open
Abstract
BACKGROUND Essential medicines lists and related policies are intended to meet the priority health needs of populations and their implementation is associated with more appropriate use of medicines. The World Health Organization (WHO) recommends that countries carefully select the medicines to be included in their national essential medicines lists. Lists that are used to prioritize access to important treatments should not include medicines that have been withdrawn elsewhere because of an unfavourable benefit-to-harm balance; however, countries still list and use medicines that have been withdrawn worldwide. The objective of this study was to determine whether the national essential medicines lists of 137 countries include medicines that have been withdrawn in other countries. METHODS AND FINDINGS We performed an audit of national essential medicines lists for medicines that had been withdrawn. Medicines withdrawn from worldwide markets between 1953 and 2014 were identified using a systematic review of published literature and regulatory documents. The reviewers used sources including the WHO's database of drugs, PubMed, and the websites of regulatory agencies to obtain information regarding adverse effects associated with the medicines, the year of first withdrawal, markets of withdrawal, and the level of evidence supporting each withdrawal. We recorded the number of countries with a withdrawn medicine included in their national medicines list, the number of withdrawn medicines included in each nation's list, and the number of national essential medicines including each withdrawn medicine. 97 medicines were withdrawn in at least one country but still included in one more national essential medicines list. Of 137 countries with a national essential medicines list, 136 lists included at least one withdrawn medicine, with 54% of the lists containing 5 or fewer withdrawn medicines, and 27% including 10 or more withdrawn medicines. 11 medicines were withdrawn worldwide but still included on at least one national essential medicines list. Countries with longer essential medicines lists had more withdrawn medicines included in their lists. CONCLUSIONS This study found that withdrawn medicines are included in all but one national essential medicines list, representing a need for more stringent processes for selecting and removing medicines on these lists. Countries may wish to apply special scrutiny to medicines withdrawn in other nations when selecting medicines to include on their lists.
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Affiliation(s)
- Onella Charles
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Igho Onakpoya
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Simran Benipal
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Hannah Woods
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Anjli Bali
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
| | - Jeffrey K. Aronson
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Carl Heneghan
- Centre for Evidence-Based Medicine, Nuffield Department of Primary Care Health Sciences, University of Oxford, Oxford, United Kingdom
| | - Nav Persaud
- MAP Centre for Urban Health Solutions, St. Michael’s Hospital, Toronto, Canada
- Department of Family and Community Medicine, St. Michael’s Hospital, Toronto, Ontario
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