WHO releases updated list of Essential Medicines; including polypills for heart, medications for multiple sclerosis

USA: The World Health Organisation (WHO) has released an updated version of its guidelines for essential medicines.

The 23rd edition of the Model Lists of Essential Medicines (EML) and the 9th edition of the Essential Medicines for Children (EMLc), published in July 2023, includes treatments for various conditions by excluding medications for obesity. 

The updated list includes important new medicine for the treatment of cancer, infectious diseases, heart conditions, and multiple sclerosis. The updated Model Lists aim to facilitate greater access to innovative medicines that show clear clinical benefits. These treatments could have a very large public health impact globally without jeopardizing the health budgets of low- and middle-income countries. 

The WHO review committee, during their meeting in April, evaluated over 100 therapeutics and proposed the addition of 24 medicines for adults and 12 for children to the Model Lists of Essential Medicines (EML) and Essential Medicines for Children (EMLc). For the 2023 update, the Committee considered 85 applications, encompassing over one hundred medicines and formulations.

The recommended changes bring the total number of medicines on the EML and EMLc to 502 and 361, respectively.

Among the notable additions to the updated list are three medications for multiple sclerosis (MS), a chronic, debilitating disease of the nervous system affecting approximately 2.8 million people worldwide. Until now, no medicines for its treatment have been included in the EML. 

In 2023 three medicines that can delay or slow its progression - glatiramer acetate, cladribine, and rituximab - are added to the EML, filling an important gap given the large global burden of MS. 

For the first time, polypills have been added to the EML for the treatment of heart disease and other cardiovascular issues. Polypills, fixed-dose combinations of multiple medicines, are meant for the prevention of diseases of the heart and blood vessels. They are made from the combinations of cholesterol-lowering agents with one or more blood pressure-lowering agents with and without acetylsalicylic acid (aspirin). 

New medicines for infectious diseases include: 

`There has also been an addition of two new cancer treatments: pegylated liposomal doxorubicin for Kaposi sarcoma and pegfilgrastim to stimulate the production of white blood cells and reduce the toxic effect of some cancer medicines on the bone marrow.

For diabetes, the current listings for human insulin on the EML and EMLc are extended to include cartridge and pre-filled pen delivery systems. 

Two new medicines acamprosate and naltrexone have been added for the treatment of alcohol use disorder.

"Updates were made to listed formulations of over 70 medicines in 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 treating severe acute malnutrition in infants and children up to 5 years old," the WHO stated. 

WHO said, “A total of 32 applications were not recommended including, 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 fast-acting oral transmucosal fentanyl for breakthrough cancer pain."