Six months into the pandemic, hospitals in Delhi appear to be cutting down on the use of tocilizumab, a rheumatoid arthritis drug that has been used for treatment of Covid-19. An experimental drug approved for Covid treatment by the Drugs Controller General of India (DCGI), it has been part of the Union Health Ministry’s Clinical Management Protocol.
In July, a phase III trial study conducted by Swiss biotech firm Roche suggested that the drug “did not demonstrate a benefit for patients in either clinical status or mortality”.
“During earlier months, we were using tocilizumab quite frequently, but over the last few months, we have limited its use to only those patients who have cytokine storm or high inflammatory markers. For medical practitioners across the globe, it has been a learning curve during which guidelines on treatment have also altered as per the need. Now less than 7% of the patients are prescribed the drug,” said Dr Atul Kakar, vice-chairman of the department of internal medicine at Sir Ganga Ram Hospital.
Doctors said tocilizumab has no role in the early stage of Covid, and can even be harmful as it can lead to a high chance of secondary bacterial and fungal infection. Therefore, in that stage, doctors look at Remdesivir, steroids, oxygen therapy or convalescent plasma.
“We have completely eliminated the use of tocilizumab and are relying on steroids, oxygen therapy and plasma therapy for patients,” said Dr B L Sherwal, medical director of Rajiv Gandhi Super Speciality hospital.
Recently, a document on FAQs on Covid treatment, prepared by top medical experts from AIIMS, was released. While experts discouraged the use of favipiravir, an antiviral that has been approved by DCGI, it said tocilizumab should only be used in patients with cytokine release syndrome once there is no active infection.
Dr Neeraj Nischal, an associate professor in the department of medicine at AIIMS said “All the therapies, whether it is remdesivir, tocilizumab or plasma, they all are experimental therapy which may be tried only in the selected group of patients. It is not meant to be administered to each and every patient, a trend which is being followed in some centres. Supportive therapy remains the mainstay of this disease. Proper oxygenation strategy and judicious use of steroids and anticoagulant in appropriate patients can be life saving.”
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