{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,5,29]],"date-time":"2026-05-29T17:45:30Z","timestamp":1780076730983,"version":"3.54.0"},"reference-count":22,"publisher":"SAGE Publications","issue":"3","license":[{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"},{"start":{"date-parts":[[2025,7,1]],"date-time":"2025-07-01T00:00:00Z","timestamp":1751328000000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["Journal of Public Health Research"],"published-print":{"date-parts":[[2025,7]]},"abstract":"<jats:p>Off-label drug use, which involves prescribing medications beyond approved indications or dosages, is common in countries like Pakistan where regulatory oversight is limited. Avastin (Bevacizumab), originally approved for cancer treatment, is widely used off-label in ophthalmology to treat conditions such as diabetic retinopathy due to its anti-VEGF effects and lower cost compared to approved alternatives like Ranibizumab. However, its intravitreal use requires strict sterility and compounding standards. In 2023, an outbreak of vision loss occurred in Punjab, Pakistan, affecting 66 patients following intravitreal Avastin injections. Investigations linked the incident to contamination caused by improper repackaging and handling outside sterile conditions, revealing significant gaps in regulatory enforcement and clinical safety protocols. This outbreak highlights the urgent need for clear national guidelines, strict compounding practices, and informed consent to ensure patient safety. Although Avastin remains valuable for ophthalmic use, its safe administration depends on rigorous quality control. Lessons from this incident should guide efforts to improve drug safety and prevent future adverse events.<\/jats:p>","DOI":"10.1177\/22799036251361620","type":"journal-article","created":{"date-parts":[[2025,7,29]],"date-time":"2025-07-29T09:48:31Z","timestamp":1753782511000},"update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":1,"title":["Off-label use of Avastin in Pakistan: Lessons from the 2023 Punjab outbreak"],"prefix":"10.1177","volume":"14","author":[{"given":"Syed Mahib","family":"Ali","sequence":"first","affiliation":[{"name":"Department of Internal Medicine, Karachi Institute of Medical Sciences, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arooba","family":"Iqbal","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zymal","family":"Hamid","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Karachi Institute of Medical Sciences, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sameer Abdul","family":"Rauf","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine, Liaquat National Medical College, Karachi, Pakistan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4632-5153","authenticated-orcid":false,"given":"Md Ariful","family":"Haque","sequence":"additional","affiliation":[{"name":"Department of Public Health, Atish Dipankar University of Science and Technology, Dhaka, Bangladesh"},{"name":"Voice of Doctors Research School, Dhaka, Bangladesh"},{"name":"Department of Orthopaedic Surgery, Yan\u2019an Hospital Affiliated to Kunming Medical University, Yunnan, China"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2025,7,29]]},"reference":[{"key":"e_1_3_3_2_2","doi-asserted-by":"publisher","DOI":"10.2298\/MPNS1502035G"},{"key":"e_1_3_3_3_2","doi-asserted-by":"publisher","DOI":"10.1001\/jamaoncol.2018.0808"},{"key":"e_1_3_3_4_2","article-title":"Prescription ethics in a low-middle income country: thematic analysis of research from Pakistan","volume":"74","author":"Ahmed T","year":"2024","unstructured":"Ahmed T, Khan C, Khan K. 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AMD - current standard of care and the Pakistani perspective. Pak J Ophthalmol 2009; 25(4).","journal-title":"Pak J Ophthalmol"},{"key":"e_1_3_3_10_2","doi-asserted-by":"publisher","DOI":"10.4103\/ijo.IJO_315_19"},{"key":"e_1_3_3_11_2","doi-asserted-by":"publisher","DOI":"10.1634\/theoncologist.2009-0317"},{"key":"e_1_3_3_12_2","doi-asserted-by":"publisher","DOI":"10.1002\/psb.1788"},{"key":"e_1_3_3_13_2","doi-asserted-by":"publisher","DOI":"10.12669\/pjms.292.3044"},{"key":"e_1_3_3_14_2","doi-asserted-by":"publisher","DOI":"10.1007\/s00417-012-2123-4"},{"issue":"6","key":"e_1_3_3_15_2","article-title":"Murphy\u2019s law and ophthalmic complications in a patient with type 1 diabetes mellitus","volume":"15","author":"Barkhane Z","year":"2023","unstructured":"Barkhane Z, Qureshi M, Jamil A, et al. Murphy\u2019s law and ophthalmic complications in a patient with type 1 diabetes mellitus. 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