Revising the who essential medicines list for paediatric rheumatology

Abstract

Introduction: The World Health Organisation (WHO) Essential Medicines List (EML) informs countries about the minimum medicine items necessary to meet priority health needs of the population (both adults and children). The EMLs guide national and institutional medicine lists, especially in Low and Middle Resource Income Countries. The current EML for paediatric rheumatology does not reflect current best practice (Foster and Scott 2020 Nature Reviews Rheumatology). The Paediatric Global Musculoskeletal Health Task Force (TF) is working to revise the WHO EML. Objectives: To explore which drugs are considered 'essential' and 'ideal' for listing in the EML under paediatric rheumatic diseases. Methods: Healthcare professionals working in paediatric rheumatology and who are TF members were invited to take part in an anonymous online survey. We had 97 responses from 43 countries (across all continents), with 1-35 years of clinical practice including: 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). The survey data was analysed applying descriptive statistics and free-text comments using qualitative techniques. Results: Most respondents (n=70/97, 72%) reported that a revised EML would improve access to medicines in their country, improve drug provision and accessibility within their clinical practice, provide assistance when negotiating with healthcare agencies, funding bodies or insurance companies and inform paediatric trainees and adult rheumatologists about paediatric rheumatology issues. They deemed that the EML should list the following drugs (Table 1). Conclusion: Respondents confirmed the need to update the WHO EML and anticipate considerable impact on clinical practice in many countries around the world. More than 80% of respondents identified 5 agents as 'essential' (oral, intra-articular and intravenous steroids, NSAIDS, Hydroxychloroquine and Methotrexate [oral and subcutaneous]) and indicated that the EML should include a wide range of synthetic and biologic DMARDS as well as other immunosuppressive agents used in the management of rheumatic diseases in children. This data will form the basis of the TF application to the WHO to revise the EML with submission planned for 2020.L6338694232021-01-13 <br />