aHUS India needs Volunteers

In India, aHUS is at the cusp of a radical new change in the way the disease is managed. Like you are probably aware, two drugs are under clinical trials in the country and the only drug currently approved elsewhere - Eculizumab - is likely to begin being sold some time next year. 

Until now, things were very different. There was little hope of getting any drugs in India. Hopefully, the coming months will see the beginning of a new dawn for aHUS patients in the country.

This is a time when we patients need to do everything we can to shape the course of drug availability and pricing so that we ensure these events do not remain mere headlines and plans on paper. Of what use is a drug trial if patients do not get access to it after approval? Of what use is drug approval if patients are unable to get it due to the lack of support from the government or pricing being within our reach?

Until now, the aHUS India Foundation did not have any volunteers. This may not be sustainable. We definitely need more hands. If a few of us come forward and pledge our support, we can work together to achieve our goals - treatment for all!

You do not need to commit a whole lot of time. What is needed is a minimal commitment. And everything is completely voluntary.

So, if you would like to be part of this, please send an email to ahusindia@gmail.com and we can discuss the way forward.

Sign up for a newsletter from aHUS India

In recent months, there have been significant developments in the context of aHUS in India such as the approval of Soliris in India and clinical trials for Crovalimab and Iptacopan. This marks an exciting period for aHUS patients, families, and doctors in India. For many years, there was little positive news regarding this disease in our country, but thankfully, that is changing.

The aHUS India Foundation is launching a newsletter to provide important updates on aHUS developments relevant to India. Given the recent advancements in aHUS treatment and research in India, we believe it is an opportune time to start this initiative. Our newsletter will be sent out approximately every 2-3 months, keeping you informed about the latest news and progress in this field.

If you would like to stay updated on these advancements, please sign up for our newsletter. Rest assured, your email and any other details you provide will remain confidential. It is crucial for us to unite, pool our resources, and advocate for ourselves because no one else will do it for us. Sign up here, and we will keep you informed. Thank you.

Soliris recommended for approval for aHUS in India

In some very welcome news for Indian aHUS patients who are not generally used to any such news, the Experts Committee under India's drug regulator, the Central Drug Standard Control Organisation (CDSCO) has recommended to grant approval to Astra Zeneca (the company that owns Alexion Pharmaceuticals) to import and market the drug Soliris (Eculizumab) in India.

Some important takeaways:

1. This approval is subject to Astra Zeneca India conducting Phase IV clinical trials to establish safety and effectiveness in the Indian population. There is no clarity yet on how this will be done and how long it will take.

2. Only "Centres of Excellence" will be authorised to prescribe this drug. This is likely to include reputed institutes such as AIIMS, PGI, Chandigarh etc.

3. There is still no clarity on when the drug will actually become available in India.

4. Most importantly, there is no information on how Astra Zeneca will price the drug. In many developed countries where the drug is available, it is one of the most expensive drugs in the world with the cost of one vial running into several lakhs of rupees and a dose being needed at least every two to four weeks.

aHUS patients and their families should be aware that the Indian government recently expanded their Rare Disease Program to increase the grant provided under this scheme from Rs. 20 lakhs to Rs. 50 lakhs. While this may still not be enough beyond a few months, at least it is a start. aHUS is also included in the list of diseases that are covered by this program. Please see this and this for more information.

After all these years of despondence, there is finally some hope for us. Clearly, we are not out of the woods yet. But there is hope that a path will emerge soon.

Crovalimab trial in India in children and adults

Just a few weeks back, we posted this article where we alerted Indian aHUS patients to a trial on Iptacopan, an oral aHUS drug. And now there is another trial for aHUS patients for the drug Crovalimab from Roche.

Crovalimab is a complement inhibitor which can be administered to patients recently diagnosed with aHUS. The Phase III trial is for both adults and children who have not yet progressed to kidney failure (are dialysis dependent). 

Here are the details of the two trials of this new drug:

Adults and Adolescents:

Information about the trial

Participating sites & Investigators (Currently Active for Enrolment)

1. All India Institute of Medical Sciences, Delhi,  Principal Investigator: Dr Aditi Sinha

2. Medanta, The Medicity, Gurugram | Principal Investigator: Dr Sidharth Sethi

3. Sawai Man Singh (SMS) Hospital, Jaipur, Principal Investigator: Dr Dhananjai Agrawal

Children:

Information about the trial

Participating sites & Investigators (Currently Active for Enrolment)

1. All India Institute of Medical Sciences, Delhi,  Principal Investigator: Dr Aditi Sinha

2. Medanta, The Medicity, Gurugram | Principal Investigator: Dr Sidharth Sethi

This is an earnest request to all nephrologists and other doctors who come across aHUS patients in India. Please take this opportunity to enrol your patients into these trials. Until now, aHUS patients had nowhere to turn to. We no at least have trials happening in the country which should hopefully, pave the way for general availability in due course.

A drug for aHUS: Currently Recruiting Adult Patients in India

Novartis is currently recruiting adult patients in India in clinical trials for its twice-a-day oral drug Iptacopan. This is a very good opportunity for clinicians in India to enrol their patients into this trial.  Here are the locations where they are recruiting patients:

• Thiruvananthapuram
• Chennai
• Vellore
• Pune
• Lucknow
• Nagpur
• Chandigarh

This trial is only for those who have not progressed to End Stage Kidney Disease requiring dialysis. They need patients who have been diagnosed recently and those have an active disease. The listing of this trial in the Clinical Trials website states that eligible patients need to have "evidence of thrombotic microangiopathy (TMA), including thrombocytopenia, evidence of hemolysis, and acute kidney injury". This is a fantastic opportunity for doctors who encounter aHUS patients who have not yet gone into kidney failure. Please give your patients a chance at a completely normal life by enrolling them in this Phase 3 trial after examining the eligibility criteria and ensuring that this trial could help your patient.

We get several emails from newly diagnosed patients who do not know what to do when they get diagnosed with this disease. This is a golden opportunity for them.

Unfortunately, when most of us with aHUS in India got diagnosed, there was no such trial going on in India and no drug was available in India. The only drug currently approved for sale across the world is Soliris (drug name: Eculizumab) from Alexion Pharmaceuticals. Soliris is not being sold in India. It is also not possible to buy the drug and import it to India as the company does not sell it to individuals just like that. 

Some companies claim to sell it to individuals but we are not sure of the authenticity or the reliability of such channels.

The drug availability for aHUS in India is slowly changing. More companies are likely to bring their drugs to the country. For clinical trials and even for sale after approvals. The way they will price their drugs is still unclear. The challenge of recovering their research costs from a very minute size of the population still remains. India is attractive for two reasons - the potentially large number of patients and the non-availability of any other drug for the disease.

So, those with aHUS - don't lose hope just yet! A solution may be coming soon.

An aHUS Drug may finally come to India!

The Atypical HUS India Foundation recently learnt of a clinical trial involving a complement inhibitor being conducted by Novartis. Iptacopan is an oral drug being manufactured by Novartis. They have also started a clinical trial for adult aHUS patients (read more here: NCT04889430) for which recruitment is ongoing.

This article titled aHUS Trial Watch 15 highlights key information for the currently enrolling Novartis APPELHUS study. With a twice daily oral delivery, and seemingly a small molecule drug rather than a biopharmaceutical, Iptacopan holds potential to become an aHUS therapeutic drug candidate which may finally address the dual issues of cost and access.

The Atypical HUS India Foundation is in touch with Novartis and they are looking for clinicians in India who might be interested in participating in this trial.

If you are a clinician interested in participating in this trial, please let us know by emailing us at ahusindia@gmail.com and we will forward your email to the right person in Novartis and hopefully connect the dots. 

Also, please let us know of any other doctors who might be interested in this adult trial and we will reach out to them as well. Thanks!

If you are an adult aHUS patient, please share this website link with your doctor and encourage them to participate in this trial.

India has never seen a trial for a complement inhibitor. So, this is a fantastic opportunity for clinicians, patients and the aHUS community in general.

Once the trial completes, hopefully, if the results are as expected, Indians may soon have access to a complement inhibitor at last!

Reflections on aHUS Awareness Day

 aHUS Awareness Day is observed on 24th September every year. The date was picked by members of the aHUS Alliance, an umbrella group of patient organisations from around the world. It started being observed only 5-6 years ago as that was around when the Alliance was formed. Every year, a flurry of activity is seen around this date. People from all over the world participate in various activities like videos of hope by patients, dissemination of information among the public and a lot of education about the disease.

And yet, with every passing year, while some countries move from one successful drug to another, Indian patients continue to die or be condemned to a life on dialysis. Some do recover after the initial flare but these are only a small proportion of the total.

I started The Atypical HUS India Foundation a few years back with the intent of providing information and support to Indian aHUS patients and their family members. When I was diagnosed way back in 1997, there was hardly anything that was known about this disease. We scoured the internet only to find small bits of information here and there. I thought having a website and social media accounts that provided information and support to Indian patients would provide at least some hope.

I was only partially correct.

When people get diagnosed and come across the aHUS India Foundation, their first question is what is the solution? They somehow cannot get their heads around a diagnosis that has a cure but is not available in India. What are the other options, they ask? My heart sinks when I get this question because I hate to have to tell them that there are no other options. Is there a way to get Eculizumab to India? There are some shady companies that claim to be able to get it to India but the quality is doubtful and the price is beyond the reach of anyone but maybe the top 0.0001% of Indians.

The US is now moving on from Eculizumab to Ravulizumab. The infusion frequency is reduced and patients would need to go only once every 1-2 months, roughly half the number of visits that Eculizumab required. Other developed countries will soon evaluate this new drug as well.

Several other drugs are supposed to be in various stages of clinical trials. The concern however is even if these drugs get approved eventually (several years from now), will they ever be brought to India? How would they be priced?

The curse of this disease is many fold. On the one hand is the severity of the disease. On the other hand is the miniscule number of patients that exist. Any drug that pharmaceutical companies develop has only a few patients to profit from. So each patient is charged a bomb.

I hate to sound negative. But the situation is hopeless. Unfortunately, I just do not see things changing in the near future at all. In India, even basic healthcare problems are far for being resolved. Just to take one example, India's infant mortality stands at 32 per 1000 births compared to the US's 5.7 and the UK's 3.9. This is hardly surprising when you see that India spends about 3.6% of its GDP on healthcare (of this, government spending is a shocking 1.3%) while the US spends about 18% and the UK spends about 10%. 

So, the problems are aplenty and the resources are few. In this dire state of affairs, how can we expect the Indian government to spend massive sums of money on drugs that will save only a few lives? If the money spent on one patient's cost of Eculizumab is spent on improving infant mortality for example, by strengthening the primary healthcare centre infrastructure in a rural village, several hundred lives can be saved. Which investment offers a better return?

And yet, try explaining that to Ananya's father. He has no clue about GDP figures and healthcare budgets. All he knows is that he lost his beautiful little daughter when there was a drug available that could cure her. But it was simply an accident of geography coupled with a cruel accident of genetics that took her away forever.