From nexium to generics: a young RUDN scientist has proposed a way to reduce the cost of pediatric reflux treatment

How does reflux esophagitis manifest?

Symptoms include frequent episodes of heartburn and discomfort behind the sternum, regular belching with sour taste, abdominal and chest pain, decreased appetite, sleep disorders, and excessive moodiness. The lack of timely treatment can provoke the development of erosive lesions and ulcers of the esophageal mucosa, cicatricial stricture (narrowing of the lumen of the esophagus), which will cause obstacles to the normal passage of food. Also, advanced reflux esophagitis increases the likelihood of esophageal cancer. PPIs are mainly used for treatment. These are effective but expensive drugs. The high price is associated with the complexity of the synthesis of active substances — they have a complex chemical structure, and some components are active only under strictly defined pH conditions. Rising equipment and infrastructure costs, research and development costs, improvements to existing formulas, as well as royalties and patenting factors are also affected.

“We analyzed 1,508 appointments for children under the age of 17. The data included the Moscow region and the pharmaceutical market (pharmacies and e-pharmacies). As a result, 83.7% of prescriptions were for the original Nexium drug and 61% for generics. The range in the price of drugs ranges from 44 to 5089 rubles. To optimize the cost of treatment with proton pump inhibitors (PPIs) in pediatrics, while maintaining high efficiency, it was proposed to use generics — they are significantly cheaper than the original drugs and retain a comparable effect. It is also worth rationalizing dosages — for example, starting therapy with the lowest effective dose and then gradually increasing it if the result is insufficient. This way you can reduce the consumption of an expensive drug and minimize side effects,” Pavel Murzov, Assistant at the Department of Pharmacy Management and Economics at RUDN University.

Which PPIs from the list of vital medicines are most beneficial for healthcare system?

Omeprazole:

• Effective and widely used in pediatrics.
• It has a convenient release form (capsules, suspension).
• Moderate cost, suitable for preferential provision.
• Esomeprazole (Nexium):
• A more modern analogue of omeprazole with similar efficacy.
• High degree of evidence regarding efficacy and safety.
• May have a high cost, but it is offset by better tolerability of medication.

“My research focuses on the rational use of medicines in pediatrics. In addition to studying proton pump inhibitors (PPIs), we plan to consider similar problems with other important groups of medicines, such as antibiotics, antihistamines, immunostimulants, and anti—inflammatory drugs,” Pavel Murzov.