WHO includes drugs against multiple sclerosis for the first time in the list of essential medicines

The World Health Organization (WHO) has updated this Wednesday the Lists of Essential Medicines for both adults and children, which include as the main novelty drugs for the treatment of multiple sclerosis, as well as against cancer, infectious diseases and cardiovascular diseases, among other pathologies.

For this update, the WHO Expert Committee on the Selection and Use of Essential Medicines has reviewed a total of 85 applications, covering more than 100 medicines and formulations. The recommended changes bring the total number of drugs on these two lists to 502 and 361, respectively.

The objective of updating these two lists is to facilitate greater access to innovative medicines that show “clear clinical benefits”. “These treatments could have a very large impact on global public health without jeopardizing the health budgets of low- and middle-income countries,” the WHO said in a statement.

At a press conference, the director general of the WHO, Tedros Adhanom Ghebreyesus, warned in this regard that “increasing prices and interruptions in the supply chain mean that all countries have more and more problems to guarantee access consistent and equitable access to many quality-assured essential medicines.

As for multiple sclerosis, until now no medication for its treatment had been included on the list.. In 2023, three drugs that can delay or slow down its progression (cladribine, glatiramer acetate, and rituximab) have been added, filling an important existing gap.

“Given the evidence base and increased affordability of rituximab, including the availability of prequalified biosimilars, it has been given priority over label alternatives as an essential medicine to treat relapsing-remitting and progressive MS,” said the secretary of WHO Essential Medicines List, Benedikt Huttner.

The list has also incorporated for the first time multidrug fixed-dose combinations (commonly called “polypills”) for the prevention of heart and blood vessel disease, particularly cholesterol-lowering agents with one or more cholesterol-lowering agents. blood pressure with and without acetylsalicylic acid (aspirin).

In infectious diseases, new drugs included on the list include ceftolozane + tazobactam, a reserve group antibiotic, effective against multi-resistant bacteria, including difficult-to-treat infections caused by 'carbapenem-resistant Pseudomonas aeruginosa'; pretomanid against multidrug-resistant or rifampicin-resistant tuberculosis; ravidasvir (in combination with sofosbuvir) for chronic hepatitis C virus infection in adults; or monoclonal antibodies for Ebola virus disease.

NEW DRUGS AGAINST CANCER

On anticancer drugs, two new treatments have been added: pegylated liposomal doxorubicin for Kaposi's sarcoma and pegfilgrastim to stimulate the production of white blood cells and reduce the toxic effect of some anticancer drugs on the bone marrow.

In addition, the indications of several pediatric oncology drugs already on the list have been expanded to include new types of childhood cancers (anaplastic large cell lymphoma, Langerhans cell histiocytosis, and Burkitt lymphoma).

Among those that have not been recommended for inclusion are several high-priced medicines, due to “concerns about their affordability and viability in low-resource settings,” the WHO explained in a statement.

Some of them had been tested and rejected at previous Committee meetings, such as PD-1/PD-L1 immune checkpoint inhibitors and osimertinib for lung cancers, and CDK4/6 inhibitors for breast cancer. .

Other drugs not included by expert opinion have been glucagon-like peptide-1 receptor agonists for weight loss in obesity; risdiplam for the treatment of spinal muscular atrophy; donepezil for the treatment of dementia due to Alzheimer's disease; CAR-T cell therapies for lymphoma; and short-acting oral transmucosal fentanyl for breakthrough cancer pain.

In diabetes, both the standard and pediatric essential medicines lists have been expanded to include cartridge and pre-filled pen delivery systems because of “their potential advantages to patients compared to vials and syringes in terms of ease of use , higher dosing precision and better adherence”.

Finally, in mental illness, the WHO experts have added two new drugs (acamprosate and naltrexone) to the list of essential drugs for the treatment of alcohol use disorder.