Expanding medicines for neurologic disorders on the WHO Model List

Abstract

The WHO Model List of Essential Medicines is a recommended formulary for high-priority diseases based on public health trends and epidemiology patterns. The biennial publication serves as a guide for countries, particularly low-and lower-middle-income countries, to develop their own national essential medicines list (EML), and many nongovernmental organizations base their medication supplies on the WHO EML. Over the last 40 years, WHO has expanded the EML in response to treatment gaps for infectious diseases, pediatrics, palliative care, and cancer. In contrast, neurotherapeutics are poorly represented on the Model List despite the global burden of neurologic disorders, which have continued to increase in the last decade. It is imperative that the neurology community advocate for more evidence-based neurologic medicines on the WHO EML. Equitable access to essential neurologic medicines is a crucial step toward reducing the treatment gap for high-burden neurologic disorders worldwide. Neurology ® 2017;88:e87-e91 GLOSSARY EML 5 essential medicines list; LMIC 5 low-and lower-middle-income countries; NGO 5 nongovernmental organization.The burden of neurologic disorders on the global population continues to increase, particularly in low-and lower-middle-income countries (LMICs).1 The most recent estimates from the Global Burden of Disease Study show that stroke is the second highest cause of mortality and morbidity worldwide.1,2 Migraine, meningitis, and dementia rank in the top 30 causes of disability-adjusted life-years, and epilepsy in the top 50, of 315 diseases and injuries studied. Numerous treatment gaps exist for high-burden neurologic disorders in LMICs, 3 and improved access to essential neurologic medicines deserves prioritization.The WHO publishes its Model List of Essential Medicines in order to guide developing countries in their national drug policies, ensure equitable access to essential medicines, and promote rational use of medicines. The essential medicines concept has inspired over 110 countries to generate a national essential medicines list (EML). In addition, many nongovernmental organizations (NGOs) that facilitate health care in resource-poor settings (e.g., United Nations High Commissioner for Refugees, Médecins Sans Frontières, and International Federation of Red Cross and Red Crescent Societies) accept donations and distribute medicines in accordance with the WHO EML. 4 Medicines selected for the Model List are associated with increased global availability in both the public and private sectors when compared to nonessential medicines. 5 The Model List has grown from 208 medicines in 1977 to over 400 medicines in the 2015 edition. It includes a core list of efficacious, safe, and cost-effective medicines relevant to a basic health care system, and a complementary list of medicines for which specialized diagnostic or monitoring facilities, specialist medical care, or specialist training are needed.6 While the WHO EML has expanded in response to treatment gaps for infectious diseases,...

An Update in Drug-Induced Thrombotic Microangiopathy

“…One of the biggest challenges in neurology is the lack of diseasespecific drugs that contributes to the increasing global burden of neurological disorders (73). Traditionally, epilepsy benefited from a wide variety of available medicines but during the last decade numerus drugs were introduced at multiple sclerosis (MS) treatment raising long-term safety considerations (74,75). Until 2018, interferon beta 1-a and 1-b, disease modifying treatments (DMTs) of MS and anticonvulsive valproic acid were the only neurologic drugs associated with thrombotic microangiopathy (3).…”

Global Health: Pediatric Neurology

“…27,[31][32][33] Availability of other neurologic medications is even more sparse, with a few medications for neurologic disorders listed as essential medicines on the WHO model list. 34 Furthermore, even when medications are theoretically available, this does not always translate into practical availability, as access to the medication remains limited by numerous other barriers, including social, financial, and geographic; thus, treatment gaps as high as 70 to 90% still exist for epilepsy in the developing world. 7,27,35 With an estimated 80% of children with neurodevelopmental disorders living in resource poor regions, 36 improved recognition of these disorders is critical.…”

The World Health Organization's Essential Diagnostics List

“…3 Yet there is little representation of neurologic treatments on the EML, including a lack of medications for dementia, multiple sclerosis, neuropathic pain, and movement disorders, as well as commonly used medications for migraine such as triptans (table ). 4 By failing to account for disorders that already lack coverage in the EML, the EDL exacerbates existing categorical oversights for neurologic disorders. [4][5][6] Of the 113 diagnostics tests included in the first edition of the EDL, only 3 explicitly pertain to neurologic diseases: the CSF cryptococcal antigen test for diagnosis of cryptococcal meningitis, the CSF nucleic acid amplification test for diagnosis of CNS tuberculosis, and CSF bacterial culture.…”