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Emicizumab and newer haemophilia treatments in India | CION Cancer Clinics
Emicizumab is a preventive injection for haemophilia A, given under the skin and much less often than factor into a vein. It works even when an inhibitor blocks factor VIII. It does not treat a bleed that has started, and it does not work in haemophilia B. It is approved in India, but supply varies. Here is who it suits, what to watch for and what else exists. At CION Cancer Clinics, our haematologist cares for anaemia, bleeding, clotting and inherited blood disorders, with ArogyaSri, CGHS and cashless insurance accepted.
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Medically reviewed by Dr. Basudev PokhrelConsultant Haematologist · last reviewed September 2026, next review due September 2027
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On this page
- What is emicizumab, and how does it work?
- How is it different from regular factor VIII?
- Who might emicizumab suit, and who not?
- What happens when someone starts emicizumab?
- What do families misunderstand about emicizumab?
- What other newer options exist, and are they in India?
- Common questions about emicizumab
The short answer
What is emicizumab, and how does it work?
Emicizumab is a preventive injection for haemophilia A, given under the skin rather than into a vein. It does part of the job that missing factor VIII normally does, so blood can clot more readily and bleeds happen less often.
What it actually does in the blood
Clotting needs two proteins, factor IX and factor X, to be brought together. In a person without haemophilia A, factor VIII acts as the bridge. Emicizumab is a laboratory-made antibody shaped to hold those same two proteins side by side. It is not factor VIII, and it does not raise the factor VIII level on your report.
Why families in India ask about it
Regular preventive factor means injections into a vein several times a week. For a small child that means finding a vein again and again, and for a family far from a centre it means travel and missed school. Emicizumab is given much less often and under the skin. For many families that is the difference between keeping to prevention and giving up on it.
Who it does not suit
It does not work in haemophilia B, von Willebrand disease or other bleeding disorders. It is not a treatment for a bleed that has already started.
This page names medicines for understanding only. It does not give doses, and your haematologist decides whether any of them suits you.Side by side
How is it different from regular factor VIII?
Preventive factor VIII
Emicizumab
Injected into a vein
Injected under the skin, like an insulin shot
Given often, because factor leaves the blood quickly
Given much less often, because it stays in the blood longer
Switched off by an inhibitor
Not switched off by a factor VIII inhibitor
Also used to treat a bleed
For prevention only; bleeds still need another medicine
Widely supplied through state programmes
Approved in India, but access and supply vary
Not sure whether this applies to you?
Ask an oncologistIs it for you
Who might emicizumab suit, and who not?
Your haematologist weighs your bleeds, veins, inhibitor status and access. These are the situations where the question usually comes up.
Haemophilia A with an inhibitor
This is where it changed care most. When an inhibitor blocks factor, prevention with bypassing medicines is hard to keep up. Emicizumab is not blocked by the inhibitor.
Severe haemophilia A without an inhibitor
It may suit children and adults who struggle with vein injections or frequent bleeds on factor. Some families still prefer factor, which also treats bleeds.
Young children with difficult veins
An injection under the skin avoids repeated vein access. Your team still plans how bleeds and any procedure will be covered.
Ask about
- Who gives the injections at home
- Training for parents
Where it does not fit
People with haemophilia B or other bleeding disorders. Anyone who cannot attend follow-up or reach a centre for bleeds. People whose other health problems raise the chance of clots need a careful discussion first.
!
A bleed on emicizumab still needs same-day care
If there is a head injury, a bleed in the neck, throat or belly, or a joint or muscle bleed that is not settling, go to the nearest emergency department or call 108. Say the person has haemophilia A and takes emicizumab. Do not give a bypassing medicine at home unless your haematologist has told you exactly which one, because some combinations can cause dangerous clots.
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Getting started
What happens when someone starts emicizumab?
A review of the whole picture
Your haematologist looks at the type and severity of haemophilia, any inhibitor reports, recent bleeds, other health problems and how you will get the medicine regularly.
A loading period
It is started with more frequent injections for a short time, then moved to a less frequent schedule. Your team sets both, and explains when the protection has built up.
Learning the injection
Parents or patients are usually taught to inject under the skin at home. Ask to practise with the nurse watching before you do it alone.
A written bleed plan
You leave with a plan for bleeds, the name of the medicine to use, and a card telling any doctor or laboratory that you take emicizumab.
Commonly believed
What do families misunderstand about emicizumab?
"With emicizumab, we will never need factor again."
Bleeds can still happen, especially after injuries. People without an inhibitor usually still need factor for bleeds and surgery. Keep the bleed plan and the medicine it names within reach.
"His blood test is normal now, so he is protected like anyone else."
Emicizumab makes some common clotting tests look normal or near normal even though haemophilia is still there. Those results do not show how protected someone is. Tell every laboratory and doctor that you take it.
"It works for all types of haemophilia."
It is made for haemophilia A only. In haemophilia B it has no effect, and other options are used instead. Check which type is written on your diagnosis report.
"If injections are fewer, we can skip one when we are busy."
Protection depends on keeping to the schedule. A missed injection can leave a gap. If one is missed, call your team for advice rather than doubling up or guessing.
Beyond emicizumab
What other newer options exist, and are they in India?
Several newer treatments have been developed, but most are not yet easy to get in India. It helps to know the names so you can ask sensible questions.
Treatments that lower a natural clotting brake
Medicines such as concizumab, marstacimab and fitusiran work by lowering proteins that normally slow clotting. Some can be used in haemophilia A or B, with or without an inhibitor. They are newer, experience with them is still building, and availability in India is limited.
Longer-acting factor and gene therapy
Some factor products stay in the blood longer, so injections are less frequent. Gene therapy aims to let the body make its own factor for a long period after a single treatment. It is offered in few countries, is very costly, and does not suit everyone, including people with some liver or antibody problems.
Getting access, and what this page cannot tell you
Whether a treatment is supplied free depends on your state programme, and those rules change. This page cannot tell you which option suits you or whether you qualify. CION's haematology team reviews your reports, discusses the case at a tumour board and coordinates with a haemophilia treatment centre for supply.
Ask your state haemophilia centre, Aarogyasri, CGHS, ECHS, EHS or PM-JAY office what is currently covered.Questions we are asked
Common questions about emicizumab
Is emicizumab available in India?
Yes, it is approved in India. Getting it regularly is another matter. It is expensive, and supply through state programmes varies. Some families receive it through a scheme or a haemophilia treatment centre. Ask your haematologist and your state centre what is currently possible for you.
Can emicizumab be used in haemophilia B?
No. It copies the bridging job of factor VIII, which is the factor missing in haemophilia A. In haemophilia B the missing factor is IX, so emicizumab has nothing to replace. People with haemophilia B use factor IX or other options your haematologist discusses.
Does it treat a bleed that has already started?
No. It is a preventive medicine. A bleed needs its own treatment, usually factor VIII for people without an inhibitor or a bypassing medicine for those with one. Your written bleed plan should say which, and it should come from your haematologist.
What side effects should we watch for?
Redness or soreness where the injection went is common and usually mild. Headache and joint pain are also reported. The serious concern is clots, mainly when certain bypassing medicines are given alongside it. Report new swelling in a leg, chest pain or sudden breathlessness the same day.
Can we give the injections at home?
Usually, once a parent or the patient has been trained. The injection goes under the skin, which many families find far easier than a vein. Store it as the pharmacist tells you, and keep a simple diary of each injection and any bleeds to bring to follow-up.
Why must we tell the laboratory about emicizumab?
It changes some common clotting tests, making them look closer to normal than the person really is. Some factor VIII and inhibitor tests also need special methods. Without being told, a laboratory or emergency doctor may misread the results and make a wrong decision.
Can someone on emicizumab have surgery or dental work?
Yes, with planning. Emicizumab alone is often not enough cover for surgery or a tooth extraction. Your haematologist plans extra medicine around the procedure. Tell the surgeon or dentist well in advance, and never book a procedure without the haematology team knowing.
Is emicizumab the same as gene therapy?
No. Emicizumab is a medicine you keep taking on a schedule. Gene therapy is a one-time treatment that aims to help the body make its own factor. Gene therapy is rarely available in India and does not suit everyone. Your haematologist can explain where each fits.
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Dr. Basudev Pokhrel reviews blood counts, transfusion needs and blood disorders, and works with the CION tumour board on blood cancers.
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Sources
- NHS — Haemophilia
- National Heart, Lung, and Blood Institute — Hemophilia
- American Society of Hematology — Hemophilia
- National Health Mission, India — National Health Mission
This page is general information, not a prescription. Do not change or stop any treatment based on what you read here. If anything is worrying you, contact your own treating team — or call our helpline and we will help you reach the right specialist.
Keep reading
Related pages
Inhibitors in HaemophiliaWhy factor can stop working, and what changesPreventive vs On-Demand TreatmentWhere regular prevention fits in haemophilia careHaemophilia Schemes and Free Factor in IndiaWhat state programmes currently supplyFactor Replacement Therapy ExplainedHow factor treats and prevents bleedsBleeding Disorders and HaemophiliaThe full guide to bleeding disorders
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