COVID Head of PGIMER, Prof. G D Puri, Dean (Academic) & Head, Dept. of Anaesthesia & Intensive Care talked on the Covid drugs
Remdesivir and Tocilizumab are not Wonder Drugs says PGI. Yes, you read it right. These are not wonder drugs for which everyone is so panic. Doctors certainly know when and how to give which medicine judiciously to the patient. Professor G D Puri, Dean (Academic) Head Dept of Anaesthesia spoke on the Clinical side of these drugs and mentioned that there is no need of Hue and Cry of not been able to have medicine in the market and patients’ attendants to get panic on it.
Remdesivir is an antiviral drug and it was the first drug to be approved by FDA USA for treatment of covid 19. Various studies have found that Remdesivir given in patients of moderate covid 19 disease (covid 19 patients developing hypoxia at room air), reduces the duration of hospitalization, only if started within the first 8 days of symptom onset.
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 the first 7 to 8 days, in patients developing room air hypoxia (oxygen saturation < 94%).
It is not likely to be beneficial after 10 days, in patients already on ventilator. It is also not indicated in patients with raised liver enzymes (>5 times normal limit). It has a potential to worsen renal functions and may cause arrhythmia, so needs to be used with caution/ under monitoring. There are very limited indications for using Remdesivir and a very narrow therapeutic window, so it should be judiciously used.
The only medicine with 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. Use of steroids in patients not having room air hypoxia is associated with increased risk of mortality. So steroids have to be used under medical supervision, judiciously.
Tocilizumab, is a strong immune system suppressant and is indicated to control “cytokine storms” 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.
In case it 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 trial setting. Only after obtaining permission from requisite authorities and informed consent from patients/relatives.