REMDESIVIR — TO USE OR NO?
Drugs such as Chloroquine, Remdesivir, Favipiravir and other experimental drugs, which were used to treat COVID-19 around the globe, have subsequently been found to be of no or limited use.
Though the WHO has issued a conditional recommendation against the use of Remdesivir in COVID-19 patients, the ICMR in its recent guidelines continues to endorse it as an ‘off label drug’ in the management of moderate to severe cases of COVID-19 infection within 10 days of onset of symptoms, points out Dr. Viswesvaran Balasubramanian, Senior Interventional Pulmonologist and Sleep Medicine Specialist, Yashoda Hospitals.
Dr Nageshwar Reddy presents a different view. “There is a lot of confusion about the use of Remedesivir, and world scientific literature is divided. The Ministry of Health in India did not recommend it. But unfortunately, if you look at the studies, there are a lot of flaws,” he says. Explaining further, Dr. Reddy says, “in all the studies, Remdesivir was used at a later stage of disease, when the patient was already very sick, either on ventilation or oxygen.” He however cites a study published in the New England Journal of Medicine, saying that “it shows that if Remdesivir is used within seven days of the start of the disease, then it is effective in reducing mortality.”
STEROIDS — WHEN AND HOW MUCH?
Unmerited use is leading to uncontrolled sugar levels in patients, and it is also thought to facilitate the rapid growth of the deadly Black Fungus. Though many patients may require steroids, the dosage and duration of use need reconsideration, especially among diabetic patients, experts feel.
Dr Reddy feels a common major mistake is taking steroids from the first day of diagnosis itself. “Steroids could worsen the infection if given too early,” he warns. “The virus starts multiplying in the body, but the body feels relaxed due to steroids (hampering the ability to fight back), and from the second week, the disease turns serious, patients require ventilator support, and then, even increasing the dose of steroids will not work,” he says. An Oxford University study has found that steroids like Dexamethasone, when used in a dose of 6 ml gm in the second week — when the cytokine storm occurs — can decrease the need for ventilator support and also bring down mortality rates. “The trial clearly mentions use of steroids in the second week, and only for those who require oxygen,” says Dr Reddy.
“There are controversies regarding drugs like Tocilizumab and immunosuppressants too,” Dr Reddy points out. In his view, Baricitinib, a drug usually used in the treatment of arthritis and is now being used increasingly to treat COVID-19 patients, “acts like a steroid without the side-effects of steroids.” He adds that “earlier, it was extremely expensive, costing around `3,000 per tablet, but now Indian companies are making it for around `30 to `40 a tablet.”
of
steroids
— DR VISWESVARAN BALASUBRAMANIAN, Senior Interventional Pulmonologist and Sleep Medicine
Specialist, Yashoda Hospitals “There’s a lot of confusion about the use of Remedesivir, and world scientific literature is divided. The Ministry of Health in India did not recommend it. Unfortunately, if you look at the studies, there are a lot of flaws. In all the studies, Remdesivir was used at a later stage of disease, when the patient was already very sick, either on ventilation or oxygen. A study published in the New England Journal of Medicine, says if Remdesivir is used within seven days of the start of the disease, then it is effective in reducing mortality.”
— DR NAGESHWAR REDDY, Chairman, Asian Institute of Gastroenterology and AIG
Hospitals
Dr Nageshwar Reddy feels a common major mistake is taking steroids from the first day of diagnosis itself. “Steroids could worsen the infection if given too early. The virus starts multiplying in the body, but the body feels relaxed due to steroids (hampering the ability to fight back), and from the second week, the disease turns serious, patients require ventilator support, and then, even increasing the dose of steroids will not work,” he says
Drugs that have proven benefits in managing the infection are often prescribed at inappropriate clinical stages of the disease — for instance, steroids like dexamethasone and methylprednisolone benefit only patients with moderate to severe COVID-19, but many doctors prescribe them for patients with mild infections as well