Department of Pharmacology and Pharmacy, LKS Faculty of Medicine, Centre for Safe Medication Practice and Research, University of Hong Kong, 2/F Laboratory Block, 21 Sassoon Road, Hong Kong Special Administrative Region, Hong Kong.
Eli Lilly Services Pvt Ltd, Bengaluru, India.
Drugs. 2022 Jul;82(11):1193-1205. doi: 10.1007/s40265-022-01751-x. Epub 2022 Aug 12.
Understanding the trend of global antifungal agent consumption could assist with identification of global healthcare policy inadequacies and promote accessibility and availability of antifungal agents.
Using pharmaceutical sales data from the IQVIA-multinational integrated data analysis system database, we assessed use of systemic antifungal agents in humans in 27 middle- and 38 high-income countries from 2008 through 2018.
Consumption of systemic antifungal agents increased from 0.50 (in 2008) to 0.92 defined daily dose (DDD)/1000 inhabitants/day (in 2018), with a compound annual growth rate of 6.2%. High-income countries remain major consumers of antifungal agents with large variance in quantities consumed, with a gradual decline in consumption in recent years. Consumption in middle-income countries increased. Itraconazole (0.32 DDD/1000 inhabitants/day), terbinafine (0.30 DDD/1000 inhabitants/day), and fluconazole (0.23 DDD/1000 inhabitants/day) were the most commonly used antifungal agents in middle- and high-income countries in 2018. Following incorporation into the World Health Organization Essential Medicines List, itraconazole consumption in middle-income countries surged. Consumption of ketoconazole slowly declined, with 5.04% annual decrease, probably due to labelling changes in 2013 to reflect hepatotoxicity concerns. The use of polyenes (0.004 DDD/1000 inhabitants/day) and echinocandins (0.003 DDD/1000 inhabitants/day) were lowest among all the antifungal drug classes.
Global consumption of triazoles and terbinafine has gradually increased in middle- and high-income countries. Life-saving antifungal agents, including echinocandins and polyenes, are available only parenterally and may be underutilized, mainly in middle-income countries. Future research on country-specific epidemiology is warranted to guide health policy coordination to ensure equitable access to appropriate use of antifungal agents.
了解全球抗真菌药物消费趋势有助于发现全球医疗保健政策的不足，并促进抗真菌药物的可及性和可获得性。
使用 IQVIA-跨国综合数据分析系统数据库中的药物销售数据，我们评估了 2008 年至 2018 年间 27 个中收入和 38 个高收入国家中人类使用系统性抗真菌药物的情况。
系统性抗真菌药物的消费从 2008 年的 0.50（定义日剂量[DDD] / 1000 居民/天）增加到 2018 年的 0.92，复合年增长率为 6.2%。高收入国家仍然是抗真菌药物的主要消费国，消费数量存在很大差异，近年来消费呈逐渐下降趋势。中收入国家的消费有所增加。伊曲康唑（0.32 DDD / 1000 居民/天）、特比萘芬（0.30 DDD / 1000 居民/天）和氟康唑（0.23 DDD / 1000 居民/天）是 2018 年中高收入国家最常用的抗真菌药物。在被纳入世界卫生组织基本药物清单后，中收入国家的伊曲康唑消费猛增。酮康唑的消费缓慢下降，年降幅为 5.04%，可能是由于 2013 年标签变化反映了肝毒性问题。多烯类（0.004 DDD / 1000 居民/天）和棘白菌素类（0.003 DDD / 1000 居民/天）的使用在所有抗真菌药物类别中最低。
中高收入国家三唑类和特比萘芬的全球消费逐渐增加。包括棘白菌素类和多烯类在内的救命抗真菌药物仅可通过肠外途径使用，可能未得到充分利用，主要是在中收入国家。需要进行针对特定国家的流行病学研究，以指导卫生政策协调，确保公平获得适当使用抗真菌药物的机会。
