世卫组织公布新的基本药物和诊断方法目录

2019-07-15 佚名 世界卫生组织

世界卫生组织(世卫组织)基本药物目录和基本诊断方法目录属于核心指导文件,可帮助各国优先考虑重要的卫生产品,这些产品应该在整个卫生系统中广泛可及并负担得起。近日发布的这两个目录主要侧重于癌症和其他全球卫生挑战,强调方案有效、重点选择明智和患者可及性的优化。谭德塞博士世界卫生组织总干事:“全球有150多个国家使用世卫组织基本药物目录来指导决策,根据证据和健康影响确定哪些药物的性价比最高。将一些最新、最

世界卫生组织(世卫组织)基本药物目录和基本诊断方法目录属于核心指导文件,可帮助各国优先考虑重要的卫生产品,这些产品应该在整个卫生系统中广泛可及并负担得起。

近日发布的这两个目录主要侧重于癌症和其他全球卫生挑战,强调方案有效、重点选择明智和患者可及性的优化。

谭德塞博士世界卫生组织总干事:“全球有150多个国家使用世卫组织基本药物目录来指导决策,根据证据和健康影响确定哪些药物的性价比最高。将一些最新、最先进的抗癌药纳入目录,是一个强有力的声明,每个人都应该获得这些救命药,而不仅仅是那些买得起它们的人。”

基本药物目录(2019)

癌症治疗:虽然近年来市场上出现了若干新的癌症治疗方法,但只有少数几种具有足够的疗效,被认为是基本的。世卫组织将五种癌症疗法的12种药物纳入新版基本药物目录,这些被认为是从存活率角度治疗黑色素瘤、肺癌、前列腺癌、多发性骨髓瘤和白血病的最佳方法。

例如,最近研发的两种免疫疗法(nivolumab和pembrolizumab)使直到近期仍无法治愈的晚期黑色素瘤的存活率提高到了50%。

抗生素:基本药物委员会通过更新AWARE类别加强了对抗生素使用的建议,指出针对最常见和最严重的感染应该使用哪些抗生素,以获得更好的治疗效果,并降低抗微生物药物耐药风险。委员会建议增加三种治疗多重耐药感染的新抗生素作为基本药物。

基本药物目录的其他更新包括:

用于预防中风的新型口服抗凝剂,可替代华法林治疗房颤和深静脉血栓。这些药物特别有利于低收入国家使用,因为与华法林不同的是,不需对其进行定期监测;

用于类风湿性关节炎和炎症性肠病等慢性炎症的生物制剂及其各自的生物类似物;

用于预防产后出血的热稳定型卡贝缩宫素。这种新配方的效果与目前的标准疗法催产素相似,但由于不需冷藏,更有利于热带国家使用;

并非呈交给基本药物目录委员会的所有意见都得到了采纳。例如,多发性硬化症药物在递交申请后就未被纳入。委员会注意到,申请书中没有包括一些目前已在许多国家上市的相关治疗方案;委员欢迎修改后的申请包含所有相关可用方案。同样,基本药物目录委员会不建议将哌甲酯这一治疗注意缺陷多动障碍的药物纳入目录,因为委员会发现其疗效估计尚有不确定性。

基本(体外)诊断方法目录

第一版基本诊断方法目录于2018年发布,主要涉及少数重点疾病——艾滋病、疟疾、结核病和肝炎。今年的目录得到扩大,囊括了更多非传染性疾病和传染病。

癌症:鉴于癌症早期诊断的重要性(70%的癌症死亡发生在低收入和中等收入国家,主要是因为大多数患者没有得到及时诊断),世卫组织在诊断方法目录中增加了12项检测,以检测直肠癌、肝癌、宫颈癌、前列腺癌、乳腺癌生殖细胞癌等各种实体肿瘤,以及白血病和淋巴瘤。为利于癌症适当诊断,新增了一个解剖病理学测试部分;这项服务必须由专门的检验实验室提供。

传染病:目录着重于在低收入和中等收入国家流行的其他传染病,如霍乱,以及被忽视的疾病,如利什曼病、血吸虫病、登革热和寨卡。

此外,针对没有实验室的社区卫生环境,新增了一个流感检测部分。

普通检测:目录还扩大到更多针对一系列不同病种和病症的普通检测,如铁检测(贫血)和用来诊断甲状腺功能障碍和镰状细胞(一种遗传性贫血,在撒哈拉以南非洲非常普遍)的检测。

另一个值得注意的更新是,新增了一个专门针对献血筛查的部分。这是世卫组织整体战略的一部分,目的是使输血更加安全。

“2018年推出的基本诊断方法目录,旨在指导检测方法的提供并改善治疗的结果。随着各国向全民健康覆盖迈进,且可用药品不断增多,拥有正确的诊断工具以确保适当治疗是至关重要的。”

——Mariangela Sim?o博士

世卫组织负责药品和卫生产品事务的助理总干事

编者按:

更新后的基本药物目录增加了28种成人用药和23种儿童用药,并规定了已纳入目录的26种产品的新用途,总计达到460种产品,被认为是满足主要公共卫生需求所必需的。虽然这个数字看起来似乎很高,但它只相当于市场上现有药物数量的一小部分。世卫组织通过集中选择,强调病人利益和明智支出,以帮助各国确定优先级和实现全民健康覆盖。

更新后的基本诊断方法目录包含46项可用于患者常规治疗以及发现和诊断各种疾病状况的普通检测,以及69项旨在发现、诊断和监测特定疾病的检测。

目录根据用户和地点分为两部分:一部分用于社区环境,包括自检;第二部分是临床实验室,包括综合或专科医疗机构。

世卫组织的两个目录都是各国制定本国目录的样本。根据当地疾病负担和现有医疗卫生服务设施状况制定的国家基本药物目录,为各国规划和落实检验服务及所需药物提供了一个良好框架。获得这些卫生产品要求具备良好的采购、有效的供应链、高质量的管理协议和合格的医疗卫生工作人员。提供有效的诊断服务,由于其以技术为基础,也取决于可靠的技术规范、精心设计且可用的实验室网络、可提供充分支持的基础设施,以及为确保安全,对用户(病人或卫生工作者)适当开展的教育。

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    2019-07-16 phoebeyan520

    学习了

    0

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    2019-07-16 龙胆草

    学习谢谢分享

    0

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    2019-07-16 183****7028

    学习

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    2019-07-15 医者仁心5538

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