© The Indian Express Pvt Ltd
Tags:
Journalism of Courage
The World Health Organisation (WHO) has included the new class of obesity and weight-loss drugs and expanded the use of certain key cancer medicines in the recently updated Model List of Essential Medicines. This list is significant as it is used by countries as a basis to draw up their own lists.
Inclusion to the WHO list signals to countries that these medicines should be added in their public health programmes for addressing important health problems. The lists of essential medicines, prepared by countries as per their own public health priorities and global recommendations, are used to ensure availability of key medicines at public health facilities, their procurement by the government as well as reimbursement for health insurance schemes.
Apart from weight loss medicines, other additions to the list include medicines for cystic fibrosis, psoriasis, haemophilia and blood-related disorders.
The WHO expert committee has added four medicines for Type 2 diabetes and obesity. This includes three GLP-1 receptor agonists — semaglutide, dulaglutide and liraglutide — along with the dual receptor GLP-1 and GIP drug tirzepatide, all of which mimic natural hormones that regulate insulin. The committee found strong evidence that these drugs can improve control over blood glucose levels, support weight loss and reduce risk of heart and kidney diseases.
“High prices of medicines like semaglutide and tirzepatide are limiting access to these medicines. Prioritizing those who would benefit most, encouraging generic competition to drive down prices and making these treatments available in primary care – especially in underserved areas – are key to expanding access and improving health outcomes,” WHO said in a statement.
The committee, however, did not recommend the inclusion of the medicine for obese individuals without co-morbidities such as Type 2 diabetes, cardiovascular diseases or chronic kidney disease “because of limited and less mature evidence for benefit for cardiovascular outcomes and mortality in this population and lack of data regarding long-term safety.”
Last year, senior scientists from the inter-government organisation had endorsed the new class of medicines. “Efforts to slow the obesity pandemic have focussed almost exclusively on policies that help embed healthy diets and regular physical activity … Although there is good evidence on the effectiveness of such policies …, it is time to recognise that multi-sectoral efforts to influence behaviours … have so far failed to treat obesity or turn the tide on the obesity pandemic. In this context, the new class of GLP-1 RAs have the potential to be transformative,” wrote Dr Francesca Celletti and Dr Francesco Branca from WHO’s department of Nutrition and Food Safety and chief scientist at WHO Dr Jeremy Farrar.
When it comes to cancers, the committee received seven applications encompassing 25 medicines. The committee recommended increasing access to PD-1/PD-L1 immune checkpoint inhibitors — a class of immunotherapy medicines that acts on the protein PD-1 — or Programmed Cell Death-1. This protein suppresses the activity of immune T-cells. So the drug releases the brakes on the immune system, allowing T-cells to recognize and attack cancer cells more effectively.
The committee added Pembrolizumab — sold under the brand name Keytruda — as the first-line of treatment for metastatic cervical cancer, metastatic colorectal cancer and metastatic non-small cell lung cancer. The committee also included atezolizumab and cemiplimab as the therapeutic alternatives for non-small cell lung cancer.
While the inclusion of the medicine for these three cancers is new, pembrolizumab was first included in the WHO model list in 2019 as an alternative therapy for the treatment of malignant melanoma — a dangerous form of skin cancer.
The experts, who evaluated the applications, did not include several other immunotherapy drugs noting the high prices for “trivial to modest gains in overall survival”. The committee noted that even with a very narrow indication for the medicines with the greatest cost-benefit ratio — these drugs are not affordable and acceptable for public health programmes in low and low middle income countries.
The committee, therefore, suggested several ways of price reduction. At the patient end, this includes optimising doses as per weight, rounding down the dose to the closest vial size and strength, longer intervals between treatments, or shorter treatments. As for governments, the committee suggested bulk purchase of these immunotherapies regardless of their targets. The cancer experts also noted that pembrolizumab has the largest potential for price reduction in the immediate future, considering biosimilar entry for the medicine in the next three to five years.
