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Covid second wave: After Remdesivir, Pune city faces shortage of Tocilizumab
For the past 15 days, the city hospitals have been facing a shortage of both drugs and are forced to look for alternativ
After Remdesivir, the city is now facing a shortage of Tocilizumab injections, an essential drug in the treatment of severe Covid-19 patients. This is the next drug to be given after Remdesivir which is used to treat patients with moderate symptoms while the latter works for those who need intensive care unit (ICU).
For the past 15 days, the city hospitals have been facing a shortage of both drugs and are forced to look for alternatives. The drug is most costly and used for patients with severe symptoms. Unlike six doses of Remdesivir patients often need only one dose of Tocilizumab.
Vitthal Sandbhor ( 60), has been hospitalised at the Baner, dedicated Covid hospital (DCH), and his family has been looking for Tocilizumab injections for the past three days, but to no avail. One of the patient’s relatives said that they tried to call relatives and friends in Mumbai to possibly send the drug to Pune, but could not get any injection and now the doctors await to begin the treatment.
Dr HK Sale, executive director of Noble hospitals, said, “There is a shortage of both, Remdesivir and Tocilizumab, in the city for the past 15 days. We have alternatives, but sometimes we do not even get the alternative medicines. We need medicines to control the spread of the infection and to stabilize the vitals.”
In the last two days, April 16 and 17, Pune district got 5,646 injections of Remdesivir when the demand has gone up to 8,209 for a day for patients.
Dr Nitin Lohokare, who runs Mahesh Smruti hospital, said, “We are facing a shortage of the drug since the past 15 days and it has been found effective earlier too when used on a patient at the right time. In the absence of the drug we are presently using Inj Alzumab 1.6 mg /kg and it is equally effective, but it has high chances of an anaphylactic reaction. T Baricitinib can also be used which is now available in India.”
However, the drug also comes with certain limitations. Dr Girish Date, senior consultant and intensivist at Sahyadri Hospitals, said, “One has to be vigilant for bacterial infection after use of Tocilizumab and hence as practice surveillance cultures are sent after 48 hours of administration of Tocilizumab to pick up any bacterial infection and act accordingly.”
“The use and dosage of Tocilizumab depends on indicators including worsening hypoxia, increased required for ventilation and markers like D-dimer, IL 6 and ferritin. It must be noted that since Covid is relatively new there has been no proven study about the efficacy of these medicines which were primarily used as a treatment in other diseases,” he said.
Pune Food and Drug Administration (FDA) officials have now stopped answering calls from relatives as the city does not have any available stock of the drug.
SB Patil, FDA joint commissioner Pune division did not respond to the calls, but a senior official confirmed that there is zero stock available of Tocilizumab in the city.
No evidence of Remdesivir drug’s effectiveness: WHO
The World Health Organisation’s (WHO) guideline development group (GDG) expert panel, which includes experts from around the world including four patients who have had Covid-19, concluded that Remdesivir has no meaningful effect on mortality or on other important outcomes for patients, such as the need for mechanical ventilation or time to clinical improvement. The panel acknowledged that the certainty of the evidence is low and said the evidence did not prove that Remdesivir has no benefit; rather, there is no evidence-based on currently available data that it does improve important patient outcomes.
Maharashtra state task force explained that while Remedesivr is not a life-saving drug in Covid, it is helpful during the second to the ninth day of illness and not thereafter. It arrests the replication of the virus and therefore reduces the in-hospital stay and convalescence of the patient by one to two days.
How does Tocilizumab work in Covid-19?
As per the US department’s National Institute of Health, the use of Tocilizumab (single intravenous dose of 8 mg/kg of actual body weight, up to 800 mg) in combination with dexamethasone (6 mg daily for up to 10 days) in certain hospitalised patients who are exhibiting rapid respiratory decompensation due to Covid-19. The patients included in this population are, recently hospitalised patients who have been admitted to the intensive care unit (ICU) within the prior 24 hours and who require invasive mechanical ventilation, non-invasive mechanical ventilation (NIV), or high-flow nasal cannula (HFNC) oxygen (>0.4 FiO2/30 L/min of oxygen flow) (BIIa) or recently hospitalized patients (not in the ICU) with rapidly increasing oxygen needs who require Noninvasive ventilation (NIV) or high-flow nasal cannula (HFNC) and have significantly increased markers of inflammation.
