Made in Nigeria: The story of bond, oxyurea and SCD

Sometimes a story has been sitting in front of you for years before you realise that it deserves to be told. For me, oxyurea is one of those stories.

As someone who has lived with Sickle Cell Disease and written about the condition for many years, I know many people within the sickle cell community who use oxyurea, a brand of hydroxyurea manufactured in Nigeria. Hydroxyurea itself is well known in sickle cell care, but I became interested in the story behind this particular medicine.

Who makes it? How did a Nigerian pharmaceutical company come to manufacture hydroxyurea? And what role has a locally manufactured medicine played in the wider effort to improve sickle cell care in Nigeria?

That journey leads to Bond Chemical Industries Limited. According to the company’s history, its beginnings were relatively modest. Bond started as a pharmacy outlet known as Bond Chemist in Lagos in 1976. It subsequently expanded from retail pharmacy into pharmaceutical importation and distribution before moving into manufacturing. Its production facility in Awe, Oyo State, was commissioned in 1988. From there, Bond developed into a Nigerian pharmaceutical manufacturer producing a range of medicines.

Among those medicines is hydroxyurea, marketed by the company as Oxyurea. For people outside the sickle cell community, the significance of hydroxyurea may not immediately be obvious. For people living with SCD, however, it is a medicine that has become an important part of modern disease-modifying treatment.

What makes the Bond story particularly interesting to me is that Oxyurea has not simply appeared on pharmacy shelves. It has also featured in Nigerian sickle cell research.

A study conducted at Jos University Teaching Hospital followed 54 children aged four to 17 with sickle cell anaemia who were treated with hydroxyurea for 12 months.

The researchers specifically identified Oxyurea as the formulation used, in 100 mg, 250 mg and 500 mg capsules.

At the end of the study period, the researchers reported reductions in painful crises, acute chest syndrome, blood transfusions and prolonged hospital admissions. Median foetal haemoglobin increased from 7.8 per cent to 14 per cent.

The study was relatively small and conducted at a single centre, so its findings should not be overstated. The researchers themselves recommended a larger multicentre study. They also reported reversible changes in white blood cell counts in some participants, reminding us that hydroxyurea is a prescription medicine requiring appropriate clinical and laboratory monitoring.

But the Oxyurea story does not end in Jos. One of the most frightening complications of sickle cell disease is stroke, particularly in children with sickle cell anaemia.

This led researchers to establish the Stroke Prevention in Nigeria, or SPIN, programme. The feasibility study examined whether hydroxyurea could be used as a practical approach to primary stroke prevention among Nigerian children with sickle cell anaemia identified as being at increased risk of stroke.

That question is particularly important in settings where the regular blood transfusion programmes traditionally used for children at high risk of stroke may be difficult to sustain because of cost, blood availability and healthcare infrastructure.

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The research subsequently developed into the SPRING trial, a multicentre, double-blind, randomised Phase 3 study involving 220 Nigerian children.

And here the Bond story and the research story meet. The published SPRING research states that the hydroxyurea used in the trial was supplied by Bond Chemical in Nigeria. The researchers used 100 mg, 250 mg and 500 mg capsules.

The study compared low-dose and moderate-dose hydroxyurea in children with sickle cell anaemia who had abnormal transcranial Doppler measurements, indicating increased stroke risk. Researchers did not find a statistically significant difference in stroke incidence between the two dosing groups, although hospitalisation rates were lower in the moderate-dose group.

There is another detail in the published research that deserves attention. The SPRING researchers explained that, when considering how their work could continue beyond the research environment, they identified Bond as a Nigerian pharmaceutical company producing hydroxyurea at a subsidised cost. That word, sustainability, matters.

Clinical research can demonstrate that an intervention works, but people living with SCD have to be able to obtain treatment outside a clinical trial. Medicines must be manufactured, distributed, prescribed, monitored and, crucially, affordable enough for patients and health systems to access them.

This is why I find the Bond story interesting. It sits at the intersection of pharmaceutical manufacturing, scientific research and the everyday realities of people living with SCD in Nigeria.

It would be wrong, however, to turn this into an advertisement. Important questions remain.

How widely available is Oxyurea across Nigeria today? How affordable is it for the average family? Is supply consistent? How does the company maintain manufacturing quality? How many people with sickle cell disease currently have access to hydroxyurea? And what more could government, pharmaceutical manufacturers, clinicians and patient organisations do together to improve access?

These are questions worth asking. For me, there is also a wider lesson.

Nigeria carries an enormous burden of SCD. The country therefore cannot only be a place where the consequences of the condition are experienced. It should also be a place where solutions are researched, developed, manufactured and made accessible.

A Nigerian company manufacturing hydroxyurea used in Nigerian sickle cell research is one example of what that can look like. And perhaps that is the most important part of the Bond story. It is not simply the story of a pharmaceutical company or a capsule.

It is part of a much bigger conversation about whether countries carrying some of the world’s greatest disease burdens can also build the research, manufacturing capacity and healthcare systems needed to respond to them. For the sickle cell community, that is a conversation worth continuing.