You’ll often hear physicians discuss therapies as either “first-line”, “second-line” or “third-line”. There are terms referring to the preference of medication to treat a medical condition based on the clinical data available regarding medication efficacy (effectiveness) and safety, and now in the managed health-care system – cost.
First line medications are those that have a proven track record to work (often by being on market the longest), are safe in majority of patients, and cost the least.
Second line medications are often used only after first-line medications fail.
Third line medications are used when second line medications fail.
Only if the doctor believes there are unique circumstances to the patient profile will he or she choose a second line drug or third line drug. However, in the case of psychotropic medications, this trend seems to be fading as doctors are choosing second- and third-line drugs as first line drugs.
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I have been trying to find the German equivalent for the terms first- second- and third-line therapy, and am having doubts: Is a first-line therapy ONLY the therapy of first choice, or could it also mean one of several therapies to be used in a line of treatment, such as radiation (first-line), followed by chimotherapy (second-line)? If this is the case, then I would have to have two different concepts in German “Therapeutikum erster, zweiter, dritter Wahl”, and something like “erstes (zweites, drittes) Therapeutikum einer kontinuierlichen Behandlung” (this is NOT an ideal translation, so comments on this very welcome!
My understanding is that first-line therapy is one option among many potential first-line therapies. Using your oncology example, let’s say that we’re treating metastatic breast cancer. Two potential first-line therapies include paclitaxel and docetaxel. If you choose paclitaxel as the first line and that therapy fails, sometimes the oncologist would use another first-line therapy like docetaxel, but in this case because docetaxel was used second, it is second-line therapy in this situation. Therapy “line” therefore refers to sequence, not choice.
Taking the psychiatric example, a patient suffering from depression may be prescribed one of several first line therapies from many potential classes of drugs. Assume the physician prescribes a drug from the SSRI class and the patient responds poorly or does not respond. The physician can prescribe another drug from the same class and the patient may have a better response.
The reason why companies want their drugs to be used first-line is because you usually get better treatment results if you are “treatment-naive” (not treated with other medication). Especially in depression therapy, once you fail the first drug (“drug A”, the second drug (“drug B”) has a lower chance to produce a response compared with using “drug B” first.