WHO’s thumbs down to Ivermectin, ICMR no to Tocilizumab
Disappointing in trials but still trusted by the anxious Covid patients. “Miracle drugs” Remdesivir, Tocilizumab, and Ivermectin and Plasma therapy continue to find favour with people pinning their hopes on them to cure themselves of Covid-19 cure in the absence of any sure-shot cure.
But, medical experts are divided over the efficacy of these so-called “miracle drugs” with the World Health Organisation (WHO) giving them thumbs down, indicating that these were false hopes in the fight against the pathogen.
Still, the patients see them as a ray of hope, which is reflected in their huge demand and black marketing and hoarding.
In fact on Tuesday, the WHO recommended against the general use of Ivermectin for Covid-19 treatment stating that it can be used only for clinical trials. The drug is typically used for the treatment of parasitic roundworm infections.
“Safety and efficacy are important when using any drug for a new indication. @WHO recommends against the use of ivermectin for #COVID19 except within clinical trials,” Soumya Swaminathan, Chief Scientist at WHO tweeted.
The warning came a day after the Goa Government decided to provide Ivermectin to all persons above 18 years of age as a prophylactic treatment of Covid-19.
Similarly, while the State Governments across the country are pulling all stops to ensure adequate availability of anti-viral Remdevisir and Tocilizumab to curb black marketing and ensure its easy availability, the government’s Covid strategists like Dr. Randeep Guleria from the AIIMS and Dr Balram Bhargava from Indian Council of Medical Research (ICMR) have asked the public to not expect much from these injections.
Dr Guleria has been from various platforms reminding the doctors to exercise caution while prescribing Remdesivir to patients and said that the drug used to treat coronavirus disease (Covid-19) is not a ‘magic bullet’. He advised doctors that the Remdesivir drug does not reduce mortality and is of no use if given to people with mild symptoms.
Again, even though various States like Delhi and Maharashtra have set up plasma banks for the needy Covid patients and social media flooded with requests for plasma donation, Dr. Guleria feels that plasma therapy has been ineffective in curing patients.
“Studies have shown that plasma therapy has a limited role and is not of much use. Less than 2% Covid-19 patients require Tocilizumab but it is being used a lot these days. The majority of patients with mild symptoms or those who are asymptomatic will improve with the treatment given to symptomatic patients,” he said recently about the ‘Miracle drugs.’
Echoing similar views, now a group of 18 clinicians and public health professionals has expressed concern over the “irrational and non-scientific” use of plasma in Covid treatment. On Tuesday in a letter addressed to the Principal Scientific Advisor to the Government, Dr VijayRaghavan, the ICMR and the AIIMS, demanded the removal of convalescent plasma therapy from national Covid clinical protocols and warned against possibilities of plasma use triggering virulent Covid variants while being of no clinical benefit among Covid patients.
The signatories include top vaccinologist Gagandeep Kang, Editor of the Indian Journal of Medical Ethics Amar Jesani, public health researcher Shahid Jameel, and other scientists including Oommen John, Gautam Menon, CS Parmesh and Anant Bhan.
However, many doctors across the States feel otherwise. Regarding antiviral drug Remdesivir to treat people infected with Covid-19, a section of doctors claimed that it is beneficial in hypoxic patients with Covid-19 (with blood oxygen saturation below 95), others feel that there is no need to wait for patients to get hypoxic. The second group of doctors says the drug should be administered if the radiological investigation, including x-ray or CT scan, shows peculiar ground-glass opacity or lung lesions.
Prof GD Puri, Intensive Care, PGI said, “ Various studies have found that Remdesivir given in patients of moderate covid 19 disease (Covid-19 patients developing hypoxia at room air), reduce the duration of hospitalization, only if started within the first 8 days of symptom onset.
“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.”
He warned: “There are very limited indications for using Remdesivir and a very narrow therapeutic window, so it should be judiciously used.”
However, critical care expert and former national president of the Indian Society of Critical Care Medicine, Subhal Dixit said, “In my opinion, all patients with lung lesions on scan should get remdesivir irrespective of hypoxia. Why wait for hypoxia to set in? I have used the drug in quite a few patients with Covid-19. My personal experience with remdisevir has been good,”
“It all depends upon the selection of patients. Starting the drug at the right time is crucial. The beneficial effects of the drug are seen after 3-4 days. The drug also helps curtail the patients’ oxygen needs,” he said, according to reports.
Regarding Tocilizumab, a strong immune system suppressant, Dr GD Puri said since it can enhance 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 pointed out.
