Tocilizumab, remdesivir no wonder drugs in reducing mortality: Expert

Tribune News Service

Chandigarh, April 22

Amid a shortage of tocilizumab and remdesivir in Chandigarh, and patients’ attendants running from pillar to post to procure these drugs, a PGI doctor dealing with Covid patients requiring critical care has clarified that both these have not been proven to reduce mortality.

Prof GD Puri, Head, Intensive Care, PGI, said, “Remdesivir is an antiviral drug and it was the first drug to be approved by the FDA, USA, for the treatment of Covid-19. Various studies have found that remdesivir given to patients with moderate disease (Covid patients developing hypoxia at room air), reduces the duration of hospitalisation, only if started within the first eight days of symptom onset.”

He said, “It doesn’t have any effect in reducing mortality. It is not effective in patients requiring high oxygen support or ventilation. So, if it has to be rationally used, use it within the first seven or eight days in patients developing room air hypoxia (oxygen saturation less than 94 per cent).”

“Remdesivir is not likely to be beneficial after 10 days, in patients are already on ventilator. It is also not recommended for patients with raised liver enzymes (greater than five times the normal limit). It has a potential to worsen renal functions and may cause arrhythmia, so it needs to be used with caution/under monitoring,” said Professor Puri.

He warned: “There are very limited indications for using remdesivir and a very narrow therapeutic window, so it should be used judiciously.”

Professor Puri said the only medicine with a definite effect on reducing mortality in critically ill patients was steroid (dexamethasone), which was beneficial only when Covid positive patients developed hypoxia at room air.

The use of steroids in patients not having room air hypoxia was associated with increased risk of mortality. So steroids have to be used under medical supervision, judiciously, he said. There is an acute shortage of tocilizumab in the country and the supply in Chandigarh has been interrupted till April 28.

Professor Puri said in case tocilizumab was not available, good supportive care, steroids and ventilation could be tried. Off-label use of any other experimental agent should only be exercised under trial setting only after obtaining permission from the requisite authorities and informed consent from patients/relatives.

Tocilizumab is a strong immune system suppressant and is indicated to control “cytokine storm” rapidly. Its use has to be guided by clinical condition of the patient. Since it can increase the incidence of secondary bacterial infections in patients, it should be used only after ruling out significant bacterial or fungal infections. Various studies have not shown any mortality benefit in critically ill patients, he said.

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