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Equitable access to medicines underpins diabetes and CKD guidelines

Equitable access to medicines underpins diabetes and CKD guidelines


2022 Guideline Update Released by KDIGO Organization for Managing People with Diabetes chronic kidney disease (CKD) highlighted the safety and extended evidence-based roles of three drug classes: SGLT2 inhibitors, GLP-1 receptor agonists, and nonsteroidal mineralocorticoid receptor antagonists.

But this key takeaway from the guidelines also highlighted the challenges of ensuring equitable and affordable access to these custom-changing drugs for U.S. patients.

The impact of the widespread adoption of these three drug classes in the routine management of patients with diabetes and CKD in the United States will “help the healthcare system and its patients and clinicians overcome personal and structural barriers.” will depend on how effective it is in Milda Saunders, M.D.When Neda Laiterapon, an editorial accompanying the 9 January publication of the 2022 Guideline Update Summary Annals of internal medicine.

The synopsis is an 11-page summary. 128 page guidelines released by Kidney disease: Improving global outcomes (KDIGO) Formed in 2022.

The recommendations in the 2022 guideline update are “stimulating in that they may alter the natural course of CKD and diabetes, but their efficacy may be significantly limited by multiple levels of barriers.” writes Saunders and Laiteerapong, two physicians from the University of London. Chicago.

“Failure to implement the KDIGO 2022 guidelines equitably could increase clinical practice variation and widen health inequalities among marginalized populations with CKD and diabetes,” they warn.

generic to the rescue

One potentially effective and pressing way to level the prescription field for CKD and diabetes patients is the sodium-glucose cotransporter 2 (SGLT2) inhibitor, glucagon-like peptide-1 (GLP-1). ) receptor agonists, and classes of non-steroidal mineralocorticoid receptor antagonists will be available in generic formulations.

Laiteerapong predicts that this will bring down prices, which in turn will increase access, and is likely to happen in at least two of the three drug classes in the near future.

Some GLP-1 receptor agonists have already escaped patent exclusivity or will do so in 2023, she notes. liraglutide By the end of 2023.

But whether its maker, Teva, will go ahead with a generic version of liraglutide is “a big question,” Literapon said in an interview. Did. it had a green light I will do so from 2017.

The only non-steroidal mineralocorticoid receptor antagonist currently on the market is Finerenone (Kerendia), which will remain off-patent for several more years, although some brands of SGLT2 inhibitors have US patents expire in 2025. In addition, Remogliflozin is an SGLT2 inhibitor It hasn’t even received marketing approval in the United States, but “we may have already lost our patent exclusivity,” Laiteerapong said.

Laiteerapong expressed optimism that the overall trajectory of access is increasing. “A lot of people have type 2 diabetesand these drugs are in demand,” she noted. insulin Affordable. “As long as people advocate and argue for equality, things will get better,” she argued.

Incentives for Formulary Listing

Laiteerapong cited other approaches that could facilitate access to these medicines. [these drugs] Medicare Advantage Plans, Medicare Part D, State Medicaid Plans, and U.S. Department of Veterans Affairs and Tricare Health Insurance This plan is available to active members of the U.S. military.

The editorial, which she co-authored with Sanders, calls on various medical groups to create a “more unified and streamlined set of recommendations” that will benefit patients with diabetes, CKD, and multiple other chronic conditions. We are also looking for future cooperation between us.

“Over the past decade, not only has there been an explosion of research on patients with multiple chronic conditions, but there has also been a growing number of societies willing to provide collaborative guidelines. We have the momentum to make it possible,” said Laiteerapong.

Laiteerapong and Saunders have not disclosed any related financial relationships.

An intern doctor. Published January 9, 2023.

Mitchel L. Zoler is a reporter for Medscape and MDedge based in the Philadelphia area. @Mitchell Zoller

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