Geneva/Zurich — Immunotherapies that have emerged as a breakthrough in treating lung cancer have been rejected for inclusion on the World Health Organisation’s (WHO’s) list of “essential medicines”, which received a biennial update on Tuesday.

The list, which includes treatments that the WHO regards as global standards that should be available everywhere, aims to help governments make the best choices for their health systems.

The WHO added 28 new medicines to the latest edition but rejected Keytruda from Merck, Opdivo from Bristol-Myers Squibb and Tecentriq from Roche for nonsmall cell lung cancer, where they have combined for billions of dollars in sales in recent years.

“The committee considered that their place in therapy for this condition is still evolving and that more data with longer follow-up are needed to better demonstrate estimates of their actual magnitude of benefit,” the WHO said.

It did recommend Keytruda and Opdivo, also known as pembrolizumab and nivolumab, for advanced melanoma, saying they had been shown to improve survival rates by 50% for a condition that was incurable until recently.

Nicola Magrini, the secretary of the WHO’s expert committee on selection and use of essential medicines, said there had been 65 applications for additions and about a third had been rejected.

The 2019 changes were based on health benefits available due to new research and new developments. Magrini said it normally took a few years for the recommendations to filter through into health systems.

Roche did not immediately comment on Tecentriq’s omission.

Another Roche medicine, the $2.4bn-per-year multiple sclerosis (MS) drug Ocrevus, also missed the cut, along with rival MS treatments Gilenya, from Novartis, and glatiramer acetate, the generic name for Teva’s Copaxone.

The WHO concluded they did not clearly show superiority to other options when considering factors including affordability. Ocrevus costs $65,000 annually, while Gilenya’s US list price runs around $100,000.

Another rejected candidate was methylphenidate, branded as Ritalin, for attention-deficit hyperactivity disorder (ADHD), which Magrini said produced “unconvincing data on efficacy for long-term benefits”.

Among the additions were anticoagulants for preventing stroke and treating deep vein thrombosis, giving an alternative to warfarin, which requires regular monitoring that can be challenging in poorer countries.

Another was carbetocin for postpartum haemorrhage, an analogue for oxytocin but without oxytocin’s refrigeration requirements.

AbbVie’s $19bn-per year blockbuster Humira, or adalimumab, as well as emerging biosimilar copies of the world’s top-selling medicine, were added for rheumatoid arthritis and inflammatory disorders.

While adalimumab is costly, the committee concluded “increased availability of biosimilar products could lead to more market competition and reduced prices”.

The WHO list also included a vaccine for dengue fever for use in some high-risk populations.

The vaccine, Sanofi’s Dengvaxia, can increase the risk of severe dengue in children who were never exposed to the virus, and is at the centre of a health scare in the Philippines, where the department of justice has said it has found probable cause to indict officials over 10 deaths.

Sanofi has repeatedly said Dengvaxia is safe and effective.

See the WHO’s report here