Analysis of Availability and Access of Anti-myeloma Drugs and Impact on the Management of Multiple Myeloma in Latin American Countries
This study examines the availability and access to multiple myeloma (MM) treatments in Latin American countries (LATAMC). It reveals disparities between public and private healthcare systems, with certain drugs being more accessible in one system over the other. The study emphasizes the need for equal access to MM treatments in public settings and highlights barriers such as drug availability and high costs. It suggests implementing national programs, promoting collaborative clinical trials, and advocating for the inclusion of essential MM drugs in global health guidelines. By addressing these disparities, we can strive towards ensuring equitable access to life-saving MM treatments in Latin America.
Important Points:
- Participants in the study represented 73% of LATAMC and 92% of the population in South American, North American, and 5 Central American and Caribbean Island nations.
- Most LATAMC have both public and private healthcare systems, with a predominance of the former.
- Uruguay and Bolivia have slightly more patients in their private systems, while Cuba only has a public system.
- Approval of new MM agents in LATAMC is handled by regulatory agencies in each country according to local regulations.
- In 2015, Thalidomide and Bortezomib had full approval, Lenalidomide had partial approval, and Carfilzomib and Pomalidomide had rare approval in LATAMC.
- Availability of new MM agents in Latin American countries in 2015 varied between public and private systems.
- Argentina, Ecuador, Mexico, Costa Rica, and Venezuela had public and private availability for all five MM agents.
- Disparities exist in the availability and access to MM treatments between public and private healthcare systems in Latin America.
- Equal access to MM treatments in public settings is crucial for improving patient outcomes.
- Barriers to access include drug availability and high costs.
- Implementing national programs and advocating for the inclusion of essential MM drugs in global health guidelines can help improve access to care.
- Collaborative clinical trials and international recognition of MM as a disease are important for advancing treatment options.
- The study highlights the need for comprehensive strategies to ensure equitable access to life-saving MM treatments in Latin America.
- Thalidomide is commonly non-marketed and generic, while Bortezomib is marketed but rarely generic, and Lenalidomide is marketed but frequently used as a generic.
- Older classes of drugs, such as alkylating agents, are not commercially available in oral forms in some public institutions.
- Intravenous Melphalan, an essential drug for MM HDT/SCT, is unavailable in a significant percentage of public health systems.
- The use of generics or biosimilars of new MM agents varies among countries, with Thalidomide being almost always non-marketed and generic.
- First-line treatments for elderly MM patients in public systems include triplets with Thalidomide, alkylating agents, and steroids.
- Bortezomib-based regimens are frequently used for both elderly and young MM patients in private systems.
- Suboptimal treatment regimens are observed in a significant percentage of public systems.
- Transplant procedures are often delayed or not performed due to a lack of investment in infrastructure and drug availability.
Authors:
Roberto José Pessoa de Magalhães Filho, Edvan Crusoe, Eloisa Riva, Willen Bujan, Guilhermo Conte, Juan Ramon Navarro Cabrera, Diana Katerine Garcia, Guilhermo Quintero Vega, Jose Macias, Jose Willian Oliveros Alvear, Mercedes Royg, Lidiane Andino Neves, Jose Luis Lopez Dopico, German Espino, Douglas Rosales Ortiz, Zurelis Socarra, Dorotea Fantl, Guillermo J. Ruiz-Arguelles, Angelo Maiolino, Vania Tietsche de Moraes Hungria, Jean-Luc Harousseau, Brian Durie
Clin Lymphoma Myeloma Leuk. 2018 Aug 29. pii: S2152-2650(18)30361-6
DOI: https://doi.org/10.1016/j.clml.2018.08.005