Mumbai: Doctors to take relook at Rs 40,000 per vial Tocilizumab's use in severe cases

MUMBAI: Public and private hospitals in the city will re-evaluate the use of anti-inflammatory drug Tocilizumab to treat coronavirus patients after recent trial findings revealed it did not reduce mortality or severity in patients with Covid-associated pneumonia.

Tocilizumab, priced at over Rs 40,000 for a 400gm vial, is one of the most expensive drugs used in Covid treatment.

At the peak of the epidemic in Mumbai, people queued up for hours for a vial or two of the drug.

On July 29, Swiss company Roche said its attempt to retool its rheumatoid arthritis drug Actemra (Tocilizumab) to treat Covid patients has failed in a Phase-III trial. Tocilizumab is given to prevent the cytokine storm—overreaction of the immune system causing inflammation—in serious patients. The trial found the percentage of patients who died by week four was no different in those who got the drug than those who didn’t.

Several doctors and hospitals TOI spoke to said while they were happy with the outcome of the drug in selected patients, the trial outcome called for a review of their own results.

Intensivists from Nair and KEM hospitals said the drug has helped many with completely clouded lungs who started turning around after three to four days of getting the medicine.

Dr Hemant Deshmukh, dean of KEM Hospital, though, said they will certainly weigh the pros and cons of having the drug in their treatment protocol. Sion Hospital’s head of medicine Dr N D Karnik said they have used Tocilizumab to treat 200 patients. “It’s not a wonder drug as many had hoped. It helped when given early in the course of an impending cytokine storm. We have strictly used one vial in most patients and even half in some as it suppresses the immunity of the person and increases the risk of a secondary infection,” said Karnik, a member of the state Covid task force.

Dr Vishal Gupta, endocrinologist and director of VG Advantage, said its use was always a “double-edged” sword. “Its use has been associated with a three- to four-fold greater incidence in secondary bacterial infection a week later. The Tocilizumab trial has helped answer many questions and healthcare professionals can take solace in knowing that the much cheaper steroids to reduce the cytokine storm was efficacious in patients at a risk of lung injury,” Gupta said. In his opinion, the use of medications that have no proven efficacy in randomized clinical trials should be avoided.

In the private sector, the trial findings have spurred vigorous discussions. Dr Rahul Pandit, head of critical care at Fortis Hospital, Mulund, said the findings have put a doubt in the minds of physicians. “We do intend to look at the details of our own patients to decide whether we will continue to use it.” Of the 300-odd critical patients treated at the hospital, only a fourth received the drug. Infectious disease consultant Dr Om Srivastava said there have been concerns about the study design being faulty. “We need to look at a more robust study.” Endocrinologist Dr Shashank Joshi said use of more than a vial was a strict no. “But more trials are awaited.”

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