Improving access to SLE therapies in low and middle-income countries

Abstract

SLE increases disease burden in those affected with it, and that is particularly the case in low- and middle-income countries. The 2019 Addressing Lupus Pillar of Health Advancement project is a multiphase initiative whose objective is to recognize, hierarchize and establish approaches for diligent SLE research, care and access to healthcare. Lack of access to high-cost medications that have been shown to be efficacious in the short term and that potentially reduce damage in SLE is a complex issue. In this review, we highlight opportunities and plans of action to diminish costs and improve access to therapies, which should be recognized and executed, preferably within regional strategies with multiple stakeholders (including supranational organizations, governments, the pharmaceutical industry, medical societies and the general population) connected with and grounded in structured and clear cost-effectiveness analysis.

A path to Glucocorticoid Stewardship: a critical review of clinical recommendations for the treatment of systemic lupus erythematosus

“…While several treatment recommendations acknowledge the GC-sparing effect of immunosuppressants and advanced therapies [ 20 , 38 , 39 ], socioeconomic barriers may prevent accessibility to these therapies, ultimately resulting in chronic GC use [ 43 ]. For example, oral GCs may be a favoured treatment option for uninsured individuals or in poorer countries due to their relatively low cost [ 7 ], while the cost of GC-sparing agents, such as biologics, is a key barrier preventing their recommendation more widely in the Asia-Pacific region [ 38 ] and in low- and middle-income countries [ 75 ]. This highlights the need for changes to healthcare policies to provide reimbursement of GC-sparing agents to help make a meaningful impact on the reduction of GC dependency in clinical practice.…”

Challenges and opportunities in access to care for systemic lupus erythematosus patients across Europe and worldwide

“…Even if a patient has medical insurance and the opportunity to be taken care by a rheumatologist, some medications are not available in LMICs. For example, the recently approved therapies for SLE (belimumab, anifrolumab and voclosporin) are not available in many LMICs [ 5 ]; furthermore, in the countries in which these treatments are available, they are not always covered by the health-care system, making their access almost impossible for those with a low socio-economic status. This lack of access to new treatments could result in an increase in the daily prednisone dose [ 17 ], with the subsequent risk of damage accrual.…”

“…Finally, LMICs should work together, promoting the availability of drugs through mass acquisitions, reducing their cost, or encouraging generics and biosimilars via more flexible patent laws [ 5 ]. Health technology assessment of these drugs should be undertaken, while recognizing the complexity of diagnosis, disease progression and management, which makes the assessments challenging [ 26 ].…”

“…As a result, patients often suffer significant delays in diagnosis [ 3 ], increasing their burden of disease and the risk of organ damage. These difficulties are even more pronounced in low- and middle-income countries (LMICs), where limited health infrastructure and resources can further restrict access to specialist care [ 4 , 5 ]. Many SLE patients in these regions lack access to essential diagnostic tests and therapies, particularly the latest biologics.…”