Explained: The drugs India is fighting Covid-19 with

Last month, the US National Institutes of Allergies and Infectious Diseases released preliminary trial results showing recovery time of Covid patients given remdesivir improved from 15 to 11 days. The Drug Controller General of India on June 1 approved a five-day regime of remdesivir. Doctors are currently prescribing it for moderately to severely ill patients. “The selection of patients and at what point to administer the drug is based on the clinician’s choice as there aren’t enough results from clinical trials,” said Dr Om Srivastava, infectious disease expert.

Remdesivir costs Rs 10,000-20,000 per vial. Gilead Sciences, the manufacturer, has signed licensing deals with Cipla, Ferozsons Labs, Hetero Labs, Jubilant Lifesciences and Mylan to expand supply in India and Pakistan.

Favipiravir

Favipiravir is an antiviral given to inhibit viral replication. It is used as an anti-influenza drug. First manufactured by Japan’s Fujifilm Toyama Chemical Ltd, it is manufactured in India by Glenmark Pharmaceutical and Strides Pharma. It is being used for moderately symptomatic to severely ill Covid patients, but access is not easy. Ten hospitals have been shortlisted for a phase III trial with mild and moderately ill Covid-19 patients. Another trial by Glenmark will test favipiravir with the drug umifenovir on 158 Covid patients.

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Tocilizumab

This is an immunosuppressant commonly used to treat for rheumatoid arthritis. In Mumbai, more than 100 severely ill Covid patients have been treated with this expensive drug (Rs 40,000-60,000 per dose) as a preventive against ventilator requirement; government hospitals are giving it free.

It was first tried in Lilavati Hospital on a 52-year-old patent, whose health did not improve as he had reached an advanced stage. In other patients a recovery is being observed although it is too early to provide data, doctors said. Dr Mohan Joshi, Dean of Nair Hospital, said over 95 per cent patients administered tocilizumab have shown recovery in civic hospitals. “We are giving this drug to breathless, patients with pneumonia and those at risk of cytokine storm (a severe immune reaction),” said Lilavati Hospital pulmonologist Dr Jalil Parkar.

A randomised control trial has begun across several centres in India. Tocilizumab is manufactured by Roche Pharma, and marketed by Cipla. In India it is sold under the brand name Actemra.

Itolizumab

This drug is commonly used for the skin disorder psoriasis, rheumatoid arthritis, multiple sclerosis, and autoimmune disorders. In India, Biocon launched it in 2013.

It is being trailled in Mumbai and Delhi on moderately to severely ill Covid patients. Initial results will come by July. “The trial will take some time. We are yet to assess its outcome,” said Dr Joshi, Nair Hospital Dean.

Hydroxychloroquine

This antimalarial drug is a subject of debate over its efficacy against Covid. The WHO halted its HCQ arm in the Solidarity Trial following a study in The Lancet, then reinstated it after a retraction by the authors.

India is the largest producer of this drug. Doctors use HCQ use in Covid patients with symptoms as mild as headache, fever, body pain, and even in critically ill patients. ICMR guidelines recommend low doses for nine days. “This drug is helping in faster recovery, but that is just preliminary assessment,” one doctor said. Others warn against side effects such as a chaotic heartbeat. Said Dr Gunjan Chanchalani, chief intensivist in Mumbai’s Bhatia Hospital, “We reduced HCQ use to very few patients after so many negative reports came in medical literature. Now we plan to completely stop using HCQ.”

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Doxycycline + ivermectin

Doxycycline is an antibiotic used to fight infection in the urinary tract, eye, or respiratory tract. Ivermectin is an anti-parasite drug for treatment of scabies, head lice, and filariasis. The combination is used to treat Covid patients with acute symptoms.

In mid-May, a Bangladesh Medical College Hospital study found 60 Covid patients given this combination had recovered. A Monash Biomedicine Discovery Institute study also found through laboratory analysis that ivermectin helps eliminate the virus in 48 hours.

“There is very little information about these two drugs on Covid-19 patients. It is still in experimental stage,” said Dr Nitin Karnik, member of the task force in Mumbai for treating critically ill patients.

Ritonavir + lopinavir

These antivirals are commonly used to treat HIV patients. They are being investigated in the Solidarity Trial. Some studies suggest they reduce mortality risk in Covid-19 patients; others have found no major improvement. Over a dozen manufacturers supply ritonavir and lopinavir in India. Doctors sometimes use the combination for severely ill patients. Several doctors The Indian Express spoke to found no remarkable impact on the recovery of patients.

Plasma therapy

This is meant for critical patients with low oxygen saturation levels, or those suffering a cytokine storm. Patients who have recovered from severe Covid-19 donate their plasma, which is then injected into other critical patients to boost their immunity. A protocol approved by ICMR is used to select which patient is best suited for plasma therapy. Preference is given to those at risk of cytokine storm, extreme breathlessness with severe pneumonia.