THIRUVANANTHAPURAM: The global shortage of anti-clotting drugs, or anticoagulants, did not affect the medication of over 2,000 haemophilia patients, thanks to a timely shift in treatment protocols by the health department.
The shortage was triggered when drug companies stopped making older medicines and focused on new ones, leaving states with limited options.
However, Kerala was not affected as in July, the health department switched to Emicizumab, a monoclonal antibody treatment that is more expensive but effective against bleeding, for all patients aged below 18.
The move helped the department manage the shortage of factor concentrate for adult patients, as the nationwide supply disruption led to serious issues.
“Factor shortage is a global issue. We have been gradually increasing the number of beneficiaries getting Emicizumab. This shift is unavoidable, but we started early and could provide treatment with minimal disruption,” said Dr Rahul U R, the state nodal officer for Child Health.
The shortage triggered protests in West Bengal and Karnataka. Tamil Nadu is now planning to buy Emicizumab to switch to the new treatment.
The health department spends around Rs 35 crore on haemophilia treatment annually. The switch to Emicizumab increased the budget, as each vial costs between Rs 50,000 and Rs 3 lakh. The additional spending is being managed by using the state’s share under the national programme. However, the department found the new treatment to be more cost-effective in the long run.
Dr Rahul said the rise in cost of using monoclonal antibody would be balanced by a reduction in the treatment required to manage complications under the factor replacement therapy. The department spent around Rs 11 crore on treating the complication using FEIBA (factor eight inhibitor bypassing activity) treatment. After switching to monoclonal antibody regimen the FEIBA treatment use came down by 50% this year, said Dr Rahul.
The advanced preventive treatment eliminated the need for bi-weekly hospital visits for injections, which had previously caused disruptions in school and work for families. Previously, preventive care involved administering blood clotting factor concentrates, which could also potentially lead to drug resistance if used indiscriminately.
In the absence of a national guideline for haemophilia, many states are in nascent stage of dealing with the disease. Health departments of various states have sought Kerala’s support in haemophilia management.
Meanwhile, haemophilia patients are not happy with the shortage, saying it has affected adult patients.
“Factor concentrate is not available in many taluk hospitals. Patients have to travel far for an injection to stop bleeding,” said Jimmy Manual, regional council chairman of the Hemophilia Federation of India.
The health department is planning to buy newer drugs, including extended half-life products, and expand the use of monoclonal antibodies as part of its strategy.