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Remdesivir, Tocilzumab no miracle drugs in reducing mortality: Expert

Thursday, 22 April 2021 (22:16 IST)
Panaji: With the Covid infections hitting a new high every day, there is a shortage of the antiviral
and Tocilzumab. The drug Remdesivir, first developed to treat hepatitis C and later tested against Ebola and the Middle East respiratory syndrome (MERS), does not hold life-saving benefits for Covid-19 patients and can only help reduce hospital stay by two or three days.

The mad rush to secure doses of the antiviral Remdesivir is unfounded as it has little or no impact on survival in those hospitalised with covid-19, according to Dr Naresh Purohit, Advisor-National Communicable Disease Control Programme.

Principal Investigator for National Integrated Disease Surveillance Programme, Dr Purohit, told UNI that in guidelines issued last year, the Indian Council of Medical Research (ICMR) said the intravenous drug Remdesivir cannot be used as standard care and remains beneficial only if used during the first ten days of infection.

Dr Purohit stressed that Remdesivir should be given only to serious Covid-19 patients. The drug should be given in hospitals and is not to be used in home settings.

“Remdesivir is not likely to be beneficial after ten 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 or under monitoring,” averred Dr Purohit.

He warned there are very limited indications for using Remdesivir and a very narrow therapeutic window, so it should be judiciously used.

The renowned Epidemiologist said people should stop panic-buying the drug.

“The rush for the drug is unfounded. It has restrictions on use and should be given only during the first nine days. It’s a drug that only reduces viral replication in the body. It does not have the potential to reduce mortality. No study of the drug, worldwide, has shown an ability to reduce mortality,” Dr Purohit averred.

He said medics may be prescribing the drug, which cuts hospital stay, to make more beds immediately available for more covid patients.

Citing his recent scientific report published in the Asia-Pacific Journal of Infectious Diseases Dr Purohit said Favipiravir is the only other antiviral being recommended besides Remdesivir. However, Favipiravir has better impact if administered during the first five to six days of Covid onset.

“Research studies in various medical journals show favipiravir was first used against SARS-CoV-2 in Wuhan. Then, as the pandemic spread through Europe, the drug was given emergency use approvals in Italy, Japan, Russia, Ukraine, Uzbekistan, Moldova and Kazakhstan,” he said.

WHO- Covid 19 technical lead, Dr Purohit, observed that Remdesivir worked in almost 95 per cent of patients. But he said it should not be considered a “miracle drug”.

“Prolonged viremia, which means longer presence of the virus in the body, requires medication in the form of antivirals. It is found that Remdesivir has worked in umpteen patients. It’s a good drug, but people should not pin their hopes on it,” Dr Purohit averred.

The noted infectious disease expert pointed out that there is an acute shortage of Tocilizumab in the country. 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.

“The only medicine with a definite effect on reducing mortality in critically ill patients is steroids (Dexamethasone), which is beneficial only when Covid positive patients develop Hypoxia at room air,” he said.

Huge variations in the prices of Remdesivir have resulted in a large increase in insurance claim rejections for cashless treatment and also black-listing of hospitals by insurance companies, he added. (UNI)

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