5 questions on COVID-19 treatment answered

The national COVID task force has dropped convalescent plasma therapy from the list of COVID-19 treatments in India. The development came even as the country is battling the world’s worst COVID-19 crisis. Till date, there is no definitive treatment or vaccine to prevent COVID-19, although scientists around the world are working tirelessly to find a cure for the disease caused by the novel coronavirus or SARS-CoV-2.

As COVID-19 cases continue to rise across the country, people are running from pillar to post in search of drugs that offer potential treatment - such as remdesivir, fabiflu (favipiravir), doxycycline, ivermectin, dexamethasone and other corticosteroids, etc. Yet, not all people who have tested positive for the virus need hospital treatment. Health experts said most people (about 80 per cent) who become ill with COVID-19 will be able to recover with home isolation. This means, only the moderate and severe COVID-19 patients will require hospitalisation, ventilators and oxygen support. With no specific treatment available for COVID-19, there is a lot of confusion among people and even medical doctors who are applying a torrent of research to patient care. Doctors at Fortis Hospital Mulund, answer some of the most frequently asked questions (FAQs) on COVID-19 treatment. Read on!

1. What medications can doctors use for patients diagnosed with COVID-19?

Remdesivir, steroids, tocilizumab, favipiravir, and ivermectin are some of the drugs widely used currently to treat COVID-19 infection. However, the timing of using these drugs (based on the condition of a patient) is important in their effectiveness. Recently, the government of India removed the off-label use of plasma therapy from the recommended treatment guidelines for COVID-19, citing its ‘ineffectiveness and inappropriate use’ in many cases. It has been reported that experts are also considering dropping remdisivir from COVID-19 treatment due to a lack of evidence of its effectiveness in treating patients. Remdisivir is being administered to COVID-19 patients who are hospitalised and severe.

Meanwhile, an antibody drug cocktail for COVID-19 treatment by pharmaceutical giant Roche received approvals for Emergency Use Authorisation from the Central Drugs Standards Control Organisation (CDSCO). 

2. Are steroids effective in the treatment of COVID-19 and do all COVID-19 patients need it?

There is evidence supporting the use of steroids in the treatment of COVID-19. The WHO’s RECOVERY trial showed that steroids can benefit COVID-19 patients, but it’s important to note that early and wrong use of these drugs can lead to more complications than benefits. The misuse of steroids has been blamed for rising black fungus (mucormycosis) cases in India. Experts have warned that taking steroid at an early stage of COVID-19 can further replicate the virus. Also, taking high doses of steroids in mild cases may lead to severe viral pneumonia. Steroids can be beneficial only in moderate to severe illnesses when oxygen saturation is falling. It is recommended that steroids be avoided in the first five days of COVID-19 infection. AIIMS Director Dr. Randeep Guleria warned that patients who got steroids early had higher mortality than those who did not. So, knowing when to give steroids to patients is critical.

3. When should a COVID-19 patient take tocilizumab?

Tocilizumab is an immunosuppressive drug used to treat rheumatoid arthritis and systemic juvenile idiopathic arthritis - a severe form of arthritis. This drug should be given only when a COVID-19 patient’s condition worsens despite other treatments like steroids, anticoagulants, etc. 

4. What about favipiravir and ivermectin? Are they safe and effective for treating COVID-19?

Favipiravir, known as Fabiflu, is an antiviral drug used to treat COVID-19 patients having mild to moderate symptoms. In June 2020, favipiravir originally designed for influenza received DCGI approval for mild and moderate COVID-19 infections in adults. However, there is not enough evidence in robust studies suggesting that it’s a good drug for COVID-19 and the drug is not being used in most countries. Although it’s not a proven treatment, Glenmark’s Fabiflu catapulted the market, capturing the number one slot in the domestic pharma market in April this year amid a huge surge in coronavirus cases. Fabiflu should be taken only if prescribed by a medical doctor and it’s not recommended for women who are breastfeeding, pregnant or suspected to be pregnant.

Ivermectin, an anti-parasite medication, has almost become a household name in India amid the COVID-19 second wave. Ivermectin is mainly used to treat patients with mild to moderate COVID-19 infection. Studies have demonstrated the effectiveness of ivermectin against coronavirus infection. Recently, a peer-reviewed study claimed that ivermectin is ineffective in both treating and preventing COVID-19. 

5. How effective is Roche’s antibody cocktail for COVID-19 and who can take it?

The company said results from the phase 3 trial involving over 4,500 high-risk, non-hospitalised Covid-19 patients, showed that REGN-COV2, a combination of two monoclonal antibodies (Casirivimab and Imdevimab) significantly reduced the risk of hospitalisation of death by 70 per cent while speeding up recovery time. The antibody cocktail is used for the treatment of COVID-19 in high-risk patients with the mild-to-moderate illness.

Former US President Donald Trump received this treatment when he was infected with COVID-19 in October last year. The antibody cocktail - a combined dose of 1200 mg (600 mg of each drug) - can either be infused intravenously or via a subcutaneous route. REGEN-COV needs to be stored at stored 2°C to 8°C.