Department of Medicine, University of Calgary, Canada (M.T.).
Department of Medicine, University of Toronto, Canada (S.S.).
Circulation. 2022 Nov 22;146(21):1627-1635. doi: 10.1161/CIRCULATIONAHA.122.059032. Epub 2022 Nov 21.
During the past few years, several innovative treatments for noncommunicable chronic disease have become available, including SGLT2i (sodium-glucose cotransporter-2 inhibitors), GLP-1a (glucagon-like-peptide 1 agonists), ARNI (angiotensin receptor-neprilysin inhibitors), and finerenone, a selective nonsteroidal mineralocorticoid receptor antagonist. Each of these medications improves clinically relevant outcomes when added to existing therapies, and the indications for their use are rapidly expanding. Because existing drug regimens are already complex and costly, ensuring that society derives the maximal benefit from these new agents represents a major challenge. This Primer discusses how society can meet this challenge, which we address in terms of 5 principles: maximizing benefit, minimizing harm, optimizing uptake, increasing value for money, and ensuring equitable access. The Primer is most relevant for stakeholders in high-income countries, but the principles are broadly applicable to stakeholders in other settings, including low- and middle-income countries. We have focused the discussion on SGLT-2i, but the 5 principles herein could be used with reference to ARNI, finerenone, or any other health product.
在过去几年中,出现了几种用于治疗非传染性慢性疾病的创新疗法,包括 SGLT2i(钠-葡萄糖共转运蛋白 2 抑制剂)、GLP-1a(胰高血糖素样肽 1 激动剂)、ARNI(血管紧张素受体-脑啡肽酶抑制剂)和非奈利酮,一种选择性非甾体盐皮质激素受体拮抗剂。当将这些药物添加到现有疗法中时,每种药物都能改善临床相关结局,而且其用途的适应证也在迅速扩大。由于现有药物治疗方案已经很复杂且昂贵,因此确保社会从这些新药物中获得最大的收益是一个主要挑战。本指南讨论了社会如何应对这一挑战,我们从五个原则的角度来解决这个问题:最大化收益、最小化伤害、优化使用、提高性价比和确保公平获取。本指南最适用于高收入国家的利益相关者,但这些原则广泛适用于包括低收入和中等收入国家在内的其他环境中的利益相关者。我们将讨论重点放在 SGLT-2i 上,但此处的五个原则也可以参照 ARNI、非奈利酮或任何其他健康产品来使用。