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 C-19 patients requiring critical care has clarified that these have not been proven in reducing mortality.
Prof GD Puri, Intensive Care, PGI said, “Remdesivir is an antiviral drug and it was the first drug to be approved by USFDA for treatment of C-19. Various studies have found that Remdesivir given in patients of moderate C-19 disease C-19 patients developing hypoxia at room air), reduces the duration of hospitalization, only if started within first 8 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 first 7 to 8 days, in patients developing room air hypoxia ( oxygen saturation < 94%).”
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“Remdesivir is not likely to be beneficial after 10 days, in patients already on a ventilator. It is also not indicated in patients with raised liver enzymes (>5 times normal limit). It has the potential to worsen renal functions and may cause arrhythmia, so needs to be used with caution/ under monitoring,” said Prof Puri.
He warned: “There are very limited indications for using Remdesivir and a very narrow therapeutic window, so it should be judiciously used.”
The only medicine with a definite effect on reducing mortality in critically ill patients is steroids (dexamethasone), which is beneficial only when C-19 positive patients develop hypoxia at room air, said Puri.
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The use of steroids in patients not having room air hypoxia is associated with an 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.
Prof Puri clarifies that in case Tocilizumab is not available, good supportive care, steroids and ventilation may be tried. Off label use of any other experimental agent should only be exercised under the trial setting. Only after obtaining permission from 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 the clinical condition of the patient. Since it can increase the incidence of secondary bacterial infections in the 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 added.
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