BENGALURU: With the state seeing a spike in cases, the treatment protocols targeting Covid patients too have gradually increased. Initially, when the number of cases were small, the state used basic medications to treat Covid cases, like anti-virals and antibiodies. But now, the state has extended the treatment protocol to use newly experimented drugs, on a case-to-case basis.Some of the drugs that have been recently incorporated are Remdivisir, Tocilizumab, Favipiravir, Dexamethasone and Methylprednisolone.
These drugs are being used after clinical trials were conducted in other countries and the results were found to be effective. For Dexamethasone, a steroid, the trials were conducted in the United Kingdom on 2,104 patients, among which reduction in mortality was observed in 33% of patients who were on ventilators and 20% who were on oxygen. This steorid, however, has no benefits on patients not on respiratory support.
The Karnataka’s Critical Care Support Team (CCST) incorporated the drug to treat critically ill Covid patients, and was approved by the Union Ministry of Health & Family Welfare. The drug is now being used only in cases with deterioration of oxygen indicators, rapid worsening in imaging and excessive activation of the body’s inflammatory response. It can be used only for a short period of time, say 3-5 days. Methylprednisolone too is used similarly.
Remdesivir and Tocilizumab, and Convalescent Plasma therapy are being used as investigational interventions based on limited availability of evidence and on defined subgroups of patients.
Convalescent Plasma therapy, too, is targeted at critical patients to reduce mortality and to speed up recovery.
Dr Anoop Amarnath, Head, Scientific Board, Chairman Geriatric Medicine, Manipal Hospitals, and a member of the CCST, said, “These medicines are used on case-to-case basis, depending on the patients’ condition. As there are very few clinical trials done, these drugs have been given emergency clearances. Normally, the clearance to use medicine is given only after six months.
“As in the case of Remdesivir, it is given in an injection form for those on oxygen. But for people with renal problems, pregnancy or lactating mothers, the medicine is not given -- nor to children below 12. Tocilizumab is an immuno-suppressant and given to patients with moderate symptoms, but who have progressive increase in oxygen requirement. While Convalescent Plasma is given through blood transfusion to critical patients who have not improved despite using steroids.”
He said that Favipiravir to treat mild and moderate symptoms, which has got clearance from DGCI, is being considered by the team and the therapeutic committee needs to give the nod. Supplemental therapy called anticoagulation is being done on patients to prevent blood clots in the lungs, while cytosorb therapy using a device to reduce pro-inflammatory cytokines levels in patients admitted to ICUs with confirmed or imminent respiratory failure, is also being pursued.
DEXAMETHASONE
It is a steroid, the trials for which were conducted in the UK on 2,104 patients, among which reduction in mortality was observed in 33% of patients who were on ventilators and 20% who were on oxygen. It is not beneficial for patients not requiring respiratory support.
REMDESIVIR
This is given as an injection for those on oxygen, but it cannot be given to patients with renal problems, pregnant women or lactating mothers, nor to children below 12.
TOCILIZUMAB
The immuno-suppressant given to patients with moderate symptoms, but who have progressive increase in oxygen requirement.
FAVIPIRAVIR
This is to treat mild and moderate symptoms. The DGCI has cleared it, but the therapeutic committee is yet to give the nod.
CYTOSORB THERAPY
This uses a device to reduce pro-inflammatory cytokine levels in patients admitted to ICU with confirmed imminent respiratory failure.