Hope dashed: WHO rejects key meds for obesity, cancer pain

The World Health Organisation (WHO) has excluded drugs meant for the management of cancer pain and obesity citing high cost.

The move comes as the UN agency warns that “rising prices and supply chain disruptions mean that all countries now face increasing problems in ensuring consistent and equitable access to many quality-assured essential medicines”.

WHO published a new Essential Medicines List (EML) which includes important new medicines for the treatment of multiple sclerosis, cancer, infectious diseases, and cardiovascular conditions, among others.

The WHO essential medicines list, which catalogues drugs that should be available in all functioning health systems, does not include a total of 32 applications.

Some of the drugs excluded are glucagon-like peptide-1 receptor agonists for weight loss in obesity. Risdiplam for treatment of spinal muscular atrophy, and donepezil for treatment of dementia due to Alzheimer disease. Also excluded is CAR-T cell therapies for lymphoma and fast-acting oral transmucosal fentanyl for cancer pain.

WHO stated that the exclusion to the high cost of patented, highly-priced treatments for lung and breast cancer prevented some cancer drugs and is the reason why some of the medicines did not make it to the updated EML and Essential Medicines for List Children (EMLc) released on Wednesday.

New medicines listed for infectious diseases include ceftolozane +tazobactam, a ‘reserve’ group antibiotic effective against multi-drug resistant bacteria, including difficult-to-treat infections caused by carbapenem-resistant Pseudomonas aeruginosa.

Others are pretomanid to treat multidrug-resistant or rifampicin-resistant tuberculosis, ravidasvir (to be used in combination with sofosbuvir) for the treatment of chronic hepatitis C virus infection in adults and monoclonal antibodies for Ebola.

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Malnutrition in infants

Other highlights are like formulations of over 70 medicines the EMLc to ensure appropriate dosage forms and strengths for use in children aged up to 12 years are included. Ready-to-use therapeutic food is added to the EMLc for the treatment of severe acute malnutrition in infants and children up to five years old.

For mental health conditions, the WHO included two new medicines–acamprosate and naltrexone–for treatment of alcohol use disorder.

The UN agency stated that the updated Model Lists aim to facilitate greater access to innovative medicines that show clear clinical benefits whose treatments could have a very large public health impact globally without jeopardizing the health budgets of low- and middle-income countries.

WHO Director-General  Dr Tedros Adhanom Ghebreyesus said the EML is a definitive, evidence-based guide to the most important medicines for delivering the biggest health impact.

“Rising prices and supply chain disruptions mean that all countries now face increasing problems in ensuring consistent and equitable access to many quality-assured essential medicines. WHO is committed to supporting all countries to overcome these obstacles to increase access with equity,” he said.

For the 2023 update, 85 applications, encompassing over 100 medicines and formulations were considered by the WHO Expert Committee on Selection and Use of Essential Medicines.  The recommended changes bring the total number of medicines on the EML and EMLc to 502 and 361, respectively.

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