Drugs used in India to treat Covid-19

Remdesivir

  • Remdesivir, which inhibits (prevents) viral replication, is an antiviral drug first developed for treating Ebola in 2014. It is one of the possible Covid-19 treatments being investigated in the WHO’s Solidarity Trial.
  • Last month, the US National Institutes of Allergies and Infectious Diseases released preliminary trial results showing recovery time of Covid patients given remdesivir improved from 15 to 11 days.
  • The Drug Controller General of India on June 1 approved a five-day regime of remdesivir and doctors are currently prescribing it for moderately to severely ill patients.
  • Gilead Sciences, the manufacturer, has signed licensing deals with Cipla, Ferozsons Labs, Hetero Labs, Jubilant Lifesciences and Mylan to expand supply in India and Pakistan.

Favipiravir:

  • Favipiravir is an antiviral drug given to inhibit viral replication and is used as an anti-influenza drug. It is being used for moderately symptomatic to severely ill Covid patients.
  • First manufactured by Japan’s Fujifilm Toyama Chemical Ltd, it is manufactured in India by Glenmark Pharmaceutical and Strides Pharma.
  • Ten hospitals have been shortlisted for a phase III trial with mild and moderately ill Covid-19 patients and another trial by Glenmark will test favipiravir with the drug umifenovir on 158 Covid patients.

Tocilizumab:

  • Tocilizumab is an immunosuppressant commonly used to treat rheumatoid arthritis. In Mumbai, more than 100 severely ill Covid patients have been treated with this expensive drug (Rs 40,000-60,000 per dose) as a preventive against ventilator requirement.
  • The drug is being given to breathless patients, patients with pneumonia and those at risk of cytokine storm (a severe immune reaction).
  • Over 95 per cent patients that have been administered tocilizumab have shown recovery in civic hospitals of Mumbai. Further, a randomised control trial has begun across several centres in India.
  • Tocilizumab is manufactured by Roche Pharma, marketed by Cipla and in India it is sold under the brand name Actemra.

Hydroxychloroquine:

  • Hydroxychloroquine is an antimalarial drug, which has been a subject of debate over its efficacy against Covid.
  • The WHO halted its HCQ arm in the Solidarity Trial following a study in The Lancet, and reinstated (restored) it later, after the authors withdrew the study.
  • ICMR guidelines, recommends HCQ for mildly or moderately ill patients, as well as patients with pneumonia, respiratory failure, and organ dysfunction for at least nine days.
  • The doses are small, ranging from 200 mg to 400 mg, and are being given mainly to patients between ages 15 and 40.
  • Several private hospitals in Mumbai have, however, stopped using HCQ to treat patients of Covid-19. Doctors in these hospitals said they had observed adverse reactions in a few patients who were being given a combination of HCQ and azithromycin.
  • Then there are other private hospitals who are using HCQ only for a very limited number of patients and it is not being used for hypertensive, diabetic, and cardiac patients, and elderly patients.

Doxycycline + ivermectin:

  • Doxycycline is an antibiotic used to fight infection in the urinary tract, eye, or respiratory tract. Ivermectin is an anti-parasite drug for treatment of scabies, head lice, and filariasis. The combination is used to treat Covid patients with acute symptoms.
  • In mid-May, a Bangladesh Medical College Hospital study found 60 Covid patients given this combination had recovered.
  • Another study at Monash Biomedicine Discovery Institute found through laboratory analysis that ivermectin helps eliminate the virus in 48 hours.
  • However, doctors have pointed that there is very little information on these two drugs and it is still in experimental stage.

Ritonavir + lopinavir:

  • Ritonavir and lopinavir are antivirals that are commonly used to treat HIV patients. The combination has been used by several doctors to treat severely ill patients and is also being investigated in the Solidarity Trial.
  • Some studies suggest they reduce mortality risk in Covid-19 patients and others have found no major improvement.
  • Over a dozen manufacturers supply ritonavir and lopinavir in India.

Itolizumab:

  • Itolizumab drug is commonly used for the skin disorder, psoriasis, rheumatoid arthritis, multiple sclerosis, and autoimmune disorders.
  • It is being trialled in Mumbai and Delhi on moderately to severely ill Covid patients. However, the medical fraternity is yet to assess its outcome as the initial results of the trial will only come by July.

Plasma therapy:

  • Plasma Therapy is meant for critical patients with low oxygen saturation levels, or those suffering a cytokine storm.
  • Patients who have recovered from severe Covid-19 donate their plasma, which is then injected into other critical patients to boost their immunity.
  • A protocol approved by ICMR is used to select which patient is best suited for plasma therapy. Preference is given to those at risk of cytokine storm, extreme breathlessness with severe pneumonia.

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