OBJECTIVES: Clinical practice guidelines from professional societies and organizations have emerged to standardize and improve care. As pharmaceutical innovation has evolved, guidelines are updated. However, the extent to which medicines are represented in the guidelines has not been elucidated. This study quantified the role of medicines in clinical practice guidelines across a range of chronic diseases over the past 20 years.

METHODS: Clinical practice guidelines published from 2000-2021 by recognized American, European, and global professional healthcare organizations were identified for five chronic diseases identified by the World Health Organization as among the top 10 causes of mortality in high-income countries: ischemic heart disease (IHD), non-small cell lung cancer (NSCLC), chronic obstructive pulmonary disease (COPD), Alzheimer’s disease (AD), and type 2 diabetes (T2D). Guidelines were reviewed to assess recommendations for different types of interventions (e.g., behavioral or lifestyle, medicines, surgical, or other), noting line of therapy and time from regulatory approval to year of guideline inclusion.

RESULTS: 92 clinical practice guidelines were reviewed. Among 184 discrete recommended interventions across five diseases, 146 (79.3%) were medicines, 21 (11.4%) were behavioral modifications, 6 (3.3%) were surgical interventions, and 11 (6%) were ‘other’ type. Behavioral modifications and medicines were most frequently recommended in the first line, whereas surgical interventions were more often recommended in subsequent lines. Recommendations evolved across guidelines as new evidence and additional therapies emerged. The time from regulatory approval of novel medicines to inclusion in guidelines varied by disease and geography.

CONCLUSIONS: Behavioral interventions and medicines are critical components of clinical practice guidelines representing the most significant proportion of treatment recommendations. New treatments were incorporated into clinical guidelines with varying speeds. Given the increasing pace of medical innovation, timely updates to clinical practice guidelines are critical to evolving the standard of care and delivering the best outcomes for patients.