Dear Editor,
The World Health Organisation (WHO) Essential Medicines List (EML) [1] informs countries about the minimum medicine items necessary to meet priority health needs of the population and guide national and institutional medicine lists, especially in Low Resource Income Countries. The current EML under medicines for ‘joint diseases in children’ does not reflect current best practice [2] and an important theme of work from the Paediatric Global Musculoskeletal Health Task Force (TF) [3] is to revise the listing for medicines relevant to paediatric rheumatic diseases.
Healthcare professionals working in paediatric rheumatology and who are TF members were invited to take part in an anonymous online survey WHO EML to explore which drugs they deemed to be ‘essential’ and ‘ideal’ for the clinical practice in their context. No reminders to the survey were sent. We had 97 responders, from 43 countries across all continents and mainly from low resource countries (Asia n = 51/97). Respondents had a range of 1–35 years of clinical practice and included consultant grade paediatric rheumatologists (n = 77), consultant general paediatricians with interest in rheumatology (n = 13), paediatric rheumatology trainees (n = 3), adult rheumatologists (n = 3) and a nurse working in paediatric rheumatology (n = 1). Survey data were analysed by applying descriptive statistics and free-text comments were analysed following standard procedures for qualitative analysis [4].
Most respondents (n = 70/97, 72%) reported that a revised EML would very likely improve access to medicines in their country, improve drug accessibility within their clinical practice, provide assistance when negotiating with healthcare agencies or insurance companies and further increase awareness about paediatric rheumatology issues. They deemed that the EML should list the drugs in Table 1; 80% respondents identified 5 agents as ‘essential’ (oral, intra-articular and intravenous corticosteroids, NSAIDS, Hydroxychloroquine and Methotrexate [oral and subcutaneous]) and a wide range of synthetic and biologic DMARDS as well as other immunosuppressive agents be included. This ‘cut off’ of 80% will form the basis of the TF application to the WHO to revise the EML with the submission planned for late 2020. It is our hope that raising awareness and improving access to appropriate therapy will lead to better outcomes for children with rheumatic diseases globally and allow for a targeted treatment approach [5].
Table 1.
Suggested medicines to be included in the WHO EML
| Drug | Should Include (Ideal) (% refers to respondents) | Inclusion ‘Essential’ |
|---|---|---|
| Oral prednisolone | 100% | 92% |
| Oral NSAIDs | 99% | 93% |
| Hydroxychloroquine | 98% | 88% |
| Intravenous Methylprednisolone | 98% | 83% |
| Methotrexate oral | 96% | 81% |
| Mycophenolate Mofetil | 95% | 77% |
| Azathioprine | 94% | 71% |
| Methotrexate subcutaneous | 91% | 80% |
| Intravenous cyclophosphamide | 91% | 77% |
| Adalimumab | 91% | 71% |
| Anakinra | 90% | 60% |
| Etanercept | 87% | 70% |
| Intra-articular corticosteroid Triamcinolone Hexacetonide | 86% | 64% |
| Intravenous Tocilizumab | 86% | 63% |
| Oral prednisolone (soluble) | 86% | 55% |
| Ciclosporin | 85% | 52% |
| Sulphasalazine | 84% | 51% |
| Subcutaneous Tocilizumab | 81% | 46% |
| Infliximab | 80% | 52% |
| Intravenous bisphosphonate (e.g. pamidronate) | 76% | 37% |
| Intra-articular corticosteroid Triamcinolone Acetonide | 72% | 28% |
| Intra-articular corticosteroid Methylprednisolone | 45% | 25% |
| Oral cyclophosphamide | 41% | 16% |
| Inhaled analgesia (nitrous oxide) | 36% | 15% |
| Thalidomide | 34% | 8% |
| Total Respondents: 97 |
Acknowledgements
We are grateful to all the Paediatric Global Musculoskeletal Task Force members who participated in the survey.
Abbreviations
- EML
Essential Medicines List
- TF
Paediatric Global Musculoskeletal Task Force
- WHO
World Health Organisation
Authors’ contributions
The concept and case of need for the survey was led by HF and CS. All authors contributed to the survey content. NS set up the online survey and analysed the data. All authors read and approved the final manuscript.
Funding
Not applicable, this work was not funded.
Availability of data and materials
All data generated or analysed during this study are included in this published article (and it's supplementary information files).
Ethics approval and consent to participate
Formal ethical approval was not required. Survey respondents consented to participation through submitting a completed online survey response.
Consent for publication
Not applicable.
Competing interests
The authors declare they have no competing interests.
Footnotes
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References
- 1.The WHO Essential Medicines List 2019 [Available from: https://www.who.int/medicines/publications/essentialmedicines/en/.
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Data Availability Statement
All data generated or analysed during this study are included in this published article (and it's supplementary information files).