Diabetics suffer as ban on affordable eye treatment continues

ISLAMABAD: Thousands of people in Pakistan are facing permanent blindness due to diabetic retinopathy following a recent ban on the ‘off-label’ but affordable use of cancer-drug Avastin for diabetic eye condition. 

Due to Avastin ban, patients are compelled to buy expensive injectable medicines, which are often not available in the market, eye specialists have warned. Diabetic retinopathy is a complication of diabetes, resulting from high blood sugar levels damaging the back of the eye (retina). 

If left undiagnosed and untreated, it can lead to blindness. As many as 30 percent of 33 million diabetic patients in Pakistan may develop diabetic retinopathy due to uncontrolled diabetes, according to specialists. 

As Avastin is not being allowed by the health authorities for the treatment of diabetic retinopathy, people are compelled to buy expensive injections of various brands leading to a surge in their prices, said Dr. Intzar Hussain Butt, an eye specialist in Lahore. 

He said price of one brand has doubled in a few weeks from Rs47,000 to Rs85,000, while a vial of another brand costs around Rs50,000, provincial and federal health authorities imposed a complete ban on the ‘off-la bel’ use of Avastin for the treatment of diabetic retinopathy and age-related macular degeneration in September 2023 after around 68 people contracted eye infections and became blind due to ‘compounding’ of the drug in unhygienic conditions and transportation from one city to another in public trans port. However, eye specialists across Pakistan expressed dissatisfaction over the ban on Avastin’s off-label use for the treatment of diabetic retinopathy. 

They argued that due to the ban, thousands of people were facing permanent blindness as Pakistan experiences an epidemic of diabetes, and most diabetics are developing diabetic retinopathy due to uncontrolled diabetes. 

"Poor compounding of Avastin caused blindness to 68 people only, but a ban on its off-label use is resulting in blindness to thousands of people in Pakistan," lamented Dr Butt. 

The alternate treatment of diabetic retinopathy, including Patizra and Eylea injections are beyond the reach of patients and often remain unavaila ble, he claimed. 

He claimed that during a caretaker government, health authorities in Punjab agreed to allow the use of Avastin for the treatment of diabetic retinopathy under strict conditions, and a notification was likely to be issued in this regard, but the government changed, and the new government has not yet taken any step in this regard. 

Another renowned oph thalmologist from Karachi, Dr Shayan Shadmani, stated that patients suffering from diabetic retinopathy and age-related macular degeneration were unable to access Avastin injections, while the alternate treatments were extremely expensive and unaffordable for most patients. 

"Injections of Avastin for diabetic retinopathy used to cost Rs3000 to Rs4000 or even less, and patients were able to afford its three injections. However, its off-label use was banned last year, and the alternate treatment is extremely expensive," Dr Shadmani deplored. 

Both eye specialists and office-bearers of the Ophthalmological Society of Pakistan (OSP) urged federal and health authorities and DRAP to address the issue urgently and create a technical working group on this issue to resolve this matter in line with the pattern of developed countries. 

They emphasized that the ban on Avastin’s off-label use was causing blindness in Pakistan. An official of the DRAP suggested that Ministry of National Health Services, Regulations, and Coordination (NHS,R&C) should look into the matter urgently and issue policy guidelines to DRAP and provincial health departments similar to the approach in the United Kingdom and some other developed and developing countries of the world. 

"Federal health ministry can create a task force or a technical working group comprising eye specialists, pharmacists and others to look into the matter," the DRAP official suggested