©
Pexels
An estimated 23 million people worldwide are living with schizophrenia, a condition that contributes substantially to the global burden of disease. Antipsychotic medicines are the cornerstone of schizophrenia treatment, helping to improve symptoms such as hallucinations and delusions, reduce relapse and lower mortality. However, as individual antipsychotic medicines differ in their effectiveness, side-effect profile and cost, access to reliable treatment remains a major challenge in low- and middle-income countries (LMICs).
It is estimated that up to two billion people in LMICs do not receive essential medicines. Medicines may be unavailable, unaffordable or inaccessible, and in some settings may be manufactured to a poor standard. At the same time, only a minority of clinical trials include populations from LMICs. This can limit the extent to which clinical evidence is applicable to these populations and may also restrict access to newer medicines, as pharmaceutical companies often prioritise markets in the Global North.
Lead author Professor Andrea Cipriani, Director of GALENOS (Global Alliance of Living Evidence on aNxiety, depressiOn and pSychosis) explained:
“Improving access to effective and well-tolerated antipsychotic medicines is an essential part of addressing inequalities in schizophrenia care. By bringing together the most robust and trustworthy evidence in a global multidisciplinary consensus meeting which included real-world perspectives from different African settings, we have developed recommendations that can help guide clinical practice and mental health policy in Africa and also other low- and middle-income countries.”
Using a rigorous methodology to select and appraise the best available data, researchers have identified specific antipsychotic medicines based on their efficacy and tolerability that should be made available in LMICs.
The work brings together three complementary approaches:
-
Evidence synthesis: Researchers used a living systematic review of the most recent and relevant meta-analyses of antipsychotics for schizophrenia, coordinated by the GALENOS team.
-
Global multidisciplinary consensus: A validated framework was used through a global, multidisciplinary consensus meeting to examine and interpret the available evidence.
-
Real-world contextualisation: Experts from four African countries - Ethiopia, Nigeria, Rwanda and South Africa - provided country-level perspectives, representing the Horn of Africa, West Africa, East Africa and Southern Africa.
The authors highlight the potential for these recommendations to support future market-shaping efforts in LMICs. Approaches used by organisations such as MedAccess and the Clinton Health Access Initiative have helped negotiate improved pricing structures and access in areas including HIV, tuberculosis and contraception. Applying for the first time similar approaches to mental health could help improve the affordability and availability of essential medicines, beginning with antipsychotics for schizophrenia.
The researchers argue that improving access to a wider and more equitable range of antipsychotic medicines should be a priority for LMICs. By combining the latest evidence with international expert consensus and experience from diverse African settings, these recommendations provide a basis for guiding treatment decisions, identifying research priorities and supporting efforts to improve access to medicines for people living with schizophrenia globally.
This work was supported and funded by Wellcome Trust, and was published in The Lancet Psychiatry.