Winrevair treats high blood pressure caused by pulmonary artery stenosis, $3,700 to $6,730
The National University Heart Center of Singapore (NUHCS) will start using sotatercept (Winrevair) to treat high blood pressure caused by pulmonary stenosis, a rare condition that affects one in 5,000 Singaporeans.
“In the past 20 years, we have only had three major classes of pulmonary hypertension drugs,” NUHCS executive director James Yip told us. Asian Healthcare. “This year, Singapore will have a proven fourth-line drug coming to the market – sotatercept.”
One bottle of pulmonary arterial hypertension (PAH) treatment every three weeks can cost up to US$6,730 (S$9,000) and as low as US$3,700 (S$5,000), depending on the means test, said cardiologist Yip. Controllable diseases such as diabetes.
He added that the injectable compound could be given to pulmonary arterial hypertension patients at state hospitals who have been treated with standard medications for years.
Singapore’s Health Sciences Authority approved Merck’s Winrevair in September, making Singapore the first country in Asia to approve the drug. The U.S. Food and Drug Administration (FDA) approved Winrevair six months ago.
Each bottle sells for about US$14,000 (S$19,000) in the United States.
Ye noted that since there is currently no cure for PAH, early detection is crucial. “For critically ill patients, the last resort is lung transplantation,” he said.
But it is difficult to go through the formalities in Singapore. “We’re not doing enough lung transplants. In fact, we haven’t done any since COVID-19 started because all the labs are closed. It’s also very costly, which is why early detection is important.
Doctors say that if left untreated, pulmonary hypertension has a survival rate comparable to that of stage II cervical cancer, but it is often mistaken for a less serious condition due to general symptoms such as shortness of breath, fatigue and leg swelling.
Rare high blood pressure, like classic high blood pressure in which pressure in blood vessels is persistently high, can also cause the heart to work harder to pump blood, eventually leading to heart failure.
Ye noted that globally, the time to diagnosis is one and a half to two years after symptoms appear. In Singapore, about a year later, Yip still sees room for improvement. “Our job is to engage the public, GPs and specialist colleagues.”
NUHCS, together with the National Heart Center of Singapore, has been actively involved in global clinical trials of drugs for hypertension caused by pulmonary artery stenosis.
“We’ve been doing clinical trials since about 2005,” Yip said. “So far, we have completed about 14 to 15 global trials. We ensure that there are at least two to three ongoing [trials] each year.
Cloud-based diagnostics
Mr Yap, who is also a joint associate professor at the Saw Swee Hock School of Public Health, said the center organizes events to educate people about typical hypertension and pulmonary hypertension. “Everyone knows about ‘normal’ high blood pressure, but this is a different kind of high blood pressure.”
The cause of pulmonary hypertension is unknown in 30 percent of patients, so early screening is wise, he said. “We need to educate them because the next member of their family may get it too.”
To diagnose the disease, a person must first undergo an ultrasound of the heart, which is time-consuming and laborious. “It takes about an hour to complete and must be performed by a trained technician.”
Ye said NUHCS is working on artificial intelligence (AI) to help them evaluate ultrasound images. “Handheld ultrasound heart exams based on cloud-based AI diagnostic devices are now available. They help untrained individuals learn how to perform heart scans in less than a week, which would normally take a year.
The hospital is also exploring other methods, such as computed tomography (CT) and magnetic resonance imaging (MRI), although their use in pulmonary hypertension has been slow to progress.
“Ultimately, artificial intelligence will further assist in analyzing these scans, allowing us to make accurate diagnoses without the need for highly specialized or extensively trained personnel to interpret the results,” Ye said.
Yap also mentioned Singapore’s role in global organizations such as the Pulmonary Vascular Institute, where he leads the Southeast Asia working group and coordinates regional activities.
He added that NUHCS maintains strong regional ties. He said the PAH Asia Pacific Alliance has 56 active pulmonary hypertension experts from eight countries who are working together to publish their experiences.
SGD 1 = US$0.75
