As Maharashtra enters the eleventh month of the Covid-19 pandemic, the dependency on immuno-modulator—tocilizumab, which was once considered the ‘miracle drug’, has increasingly diminished. Now, as most of the patients are mild to moderately infected, the doctors are mostly relying on antivirals—remdesivir. The oxygen demand has declined by almost 40% since December 2020, due to better clinical outcomes in Covid-19 care.
“In May, when the state had the highest number of Covid-19 cases, the demand for tocilizumab went up high. We instructed all the manufacturers to speed up their production. But now, the demand has fallen by almost 70-80%,” said JB Mantri, former joint commissioner (drugs) in the Food and Drug Administration (FDA) who retired on December 31, 2020.
Doctors cite several reasons behind the change in trend. Tocilizumab is prescribed to seriously Covid-19 infected patients who develop ‘cytokine storm’ when the body’s immunity starts working against its cells and damages organs which can be fatal. However, remdesivir is provided to mildly and moderately-ill patients in the early stage of their treatment. In the last eleven months, due to early diagnosis, the number of severely infected patients has decreased drastically in the state which has limited the usage of tocilizumab.
“The demand for tocilizumab has come down. Firstly, due to the early diagnosis, the condition of the patients aren’t deteriorating to an extent to use tocilizumab. Secondly, the early use of remdesvir and steroid treatment has made a huge difference. Convalescent plasma therapy is also effective,” said Dr Arpita Dwivedi, head of critical care unit at LH Hiranandani Hospital, Powai.
Other than this, doctors have observed that the repurposed drug—tocilizumab doesn’t prove effective in the treatment of Covid-19 patients. On October 21, the New England Journal of Medicine published a study on 243 patients that found tocilizumab did not reduce the risk of intubation or death as of four weeks in moderately ill Covid-19 patients.
“Now that we are almost one year since Covid-19 outbreak, several significant researches have been done into it (tocilizumab). But it has failed to show mortality benefits in Covid-19 patients. The increased risk of superadded bacterial and fungal infections is also one of the major reasons to avoid tocilizumab,” said Dr Prashant Borade, head, critical care unit, Global Hospitals, Mumbai. Dr Dwivedi also said that she avoids the usage of tocilizumab for elderly patients given the increased risk of infections.
The state Covid-19 task force has also removed the usage of tocilizumab from their treatment protocol.
Fall in oxygen demand due to lesser patients:
The oxygen demand has gone down from around 900 metric-tonne to around 400 metric-tonne recently due to the decrease in Covid-19 case and early diagnosis.
“Due to the sudden rise in the demand for oxygen in the middle of last year, we doubled up the production rate. Now, the manufacturers have so much oxygen in stock that they are wanting to sell those,” said Mantri.
Hospitals which had to refill the oxygen cylinders daily are now refining the cylinders thrice a week.
“The demand has gone down by 70% to 80% as the number of patients has reduced. Also, the patients coming in with severe disease have reduced as early diagnosis and medical attention have improved. In general, awareness of preventive health care benefits has increased,” added Dr Borade.
“Due to early diagnosis, the admission in an intensive care unit (ICU) has also dropped significantly in the last two weeks. Overall, there has been almost a 60% drop in patients who require oxygen,” said Dr Dwivedi.
The severity of the infection has reduced with early diagnosis and close monitoring. The state’s fatality rate has dropped down to 2.56%. Out of the 52,902 active Covid-19 patients, over 85% are mostly either asymptomatic or mildly and moderately symptomatic.
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