Explained: The drugs, treatment available for Covid-19 in India now

Coronavirus (Covid-19) Medicine Latest Update: Companies have launched generic versions of Remdesivir and Favipiravir for Covid-19 treatment in specific cases while UK has authorised use of steroid dexamethasone.

Coronavirus (Covid-19) Medicine: While there is no specific proven treatment for the novel coronavirus yet, patients are being administered different drugs that were approved for treating other diseases. With pharmaceutical companies launching generic versions of Remdesivir and Favipiravir for Covid-19 treatment, it has been found that they help reduce viral load but are not “game changers”.

India has also authorised off-label use of tocilizumab and convalescent plasma therapy on specific groups of patients. Moreover, India has also been using hydroxychloroquine, an antimalarial drug that has been a subject of debate over its efficacy against Covid-19, as a prophylactic drug. Recently, WHO halted its testing as part of the Solidarity Trial after data showed that the drug does not result in the reduction of mortality of hospitalised COVID-19 patients.

Besides, the UK government last week authorised the state-funded National Health Service (NHS) to use low-cost, widely used steroid dexamethasone, which has proven to reduce the risk of death among severely ill patients.

Drugs, treatment presently available for coronavirus (Covid-19)

1. Remdesivir

Originally developed by US-based biopharma company Gilead Sciences, Remdesivir is an antiviral that was used for the treatment of Ebola and has been repurposed for treatment of Covid-19. Part of the Word Health Organisation’s ongoing Solidarity Trials, Remdesivir received emergency use authorisation by the United States Food and Drug Administration (USFDA) on May 1.

? How Remdesivir works?

Remdesivir is designed to obstruct the viral replication of SARS-CoV-2. This is the stage when the virus creates copies of itself, followed endlessly by the copies creating copies of themselves.

Coronaviruses are RNA viruses and at the replication stage the key viral protein at play is an enzyme called RNA-dependent RNA polymerase (RdRp). Remdesivir mimics a part of the viral RNA and it inserts itself into the RNA strand during the replication stage. When attached, the drug prevents any further copying, leaving the RNA strand incomplete and unable to produce critical viral parts.

? What is the dose and usage recommended?

The Drugs Controller General of India approved Remdesivir for the treatment of suspected or laboratory-confirmed cases of Covid-19 in adults and children hospitalised “with severe disease” on June 1. Doctors are currently prescribing it for moderately to severely ill patients.

According to the guidelines, remdesivir’s usage should be limited to only five days. A dose of 200 mg should be given on the first day followed by 100 mg dosage for the remaining days. Moreover, it should not be given to pregnant patients, children under 12 years and patients with severe kidney impairments.

? Which firms are manufacturing Remdesvir and what are the costs?

On June 21, the Central Drugs Standard Control Organisation gave approval to Hetero Drugs and Cipla to manufacture and market remdesivir. Both the firms have already entered into non-exclusive licensing agreements with Gilead Sciences, which is the patent holder of the drug remdesivir.

Hetero has said the drug, named Covifor, will be available in 100 mg vials (injectable), which has to be administered intravenously in a hospital setting. Hetero Group of Companies MD Vamsi Krishna Bandi told PTI the price of its remdesivir will be in the range of Rs 5,000-6,000 per dose.

Cipla Ltd has announced that the generic version of remdesivir will be sold under the brand name Cipremi. The medicine is in the form of lyophilised powder for injection (100 mg). Prices of the drug in the Indian market are yet to be announced by Cipla.

2. Favipiravir

Favipiravir is an antiviral given to inhibit viral replication. It is used as an anti-influenza drug. Originally it was manufactured by Japan’s Fujifilm Toyama Chemical Ltd.

? How Favipiravir works?

Since the novel coronavirus is an RNA virus, studies have shown that favipiravir gets activated inside the cells and then gets incorporated into the viral RNA. It restricts the multiplication of the virus in the body of the host once it gets inside a host cell, reducing viral load.

Favipiravir has shown clinical improvement of up to 88 per cent in mild to moderate Covid-19 cases, an official statement said.

Explained: How close are we to a COVID-19 vaccine? What’s the testing process?

? What is the dose and usage recommended?

Favipiravir can be used in Covid-19 patients with co-morbid conditions such as diabetes and heart disease with mild to moderate Covid-19 symptoms. It offers rapid reduction in viral load within four days and provides faster symptomatic and radiological improvement.

The recommended dose of the drug is 1800 mg twice daily on Day 1, followed by 800 mg twice daily up to day 14.

? Which firms are manufacturing Favipiravir and what are the costs?

Glenmark Pharmaceuticals has launched the drug under the brand name FabiFlu, making it the first oral Favipiravir-approved medication in India for the treatment of Covid-19. The firm has fixed its price at Rs 103 per tablet.

3. Dexamethasone

Dexamethasone is a generic steroid widely used in other diseases to reduce inflammation. The steroid medicine has been available as a generic for decades. It is used to treat a range of diseases, including rheumatism, asthma, allergies and even to help cancer patients better handle the nausea triggered by chemotherapy.

? How Dexamethasone works?

Steroid drugs reduce inflammation, which sometimes develops in Covid-19 patients as the immune system overreacts to fight the infection. The UK-based RECOVERY trial results have shown dexamethasone reduces death by up to a third in Covid-19 patients on ventilator support, and by a fifth in patients receiving only oxygen.

Dexamethasone is categorised under corticosteroids, which closely mimic cortisol, the hormone naturally produced by the adrenal glands in humans.

? What is the dose and usage recommended?

Six mg of Dexamethasone per day was administered to 2,104 patients for 10 days in the UK trial. The UK study found no evidence of benefit for patients who did not require oxygen.

India has already been using steroids for moderate to severely ill Covid-19 patients. The latest Health Ministry guidelines recommends Methylprednisolone for three days in moderate illness and five-seven days for severe illness.

? Which firms are manufacturing Dexamethasone and what are the costs?

The United Kingdom has authorised the state-funded National Health Service (NHS) to use steroid dexamethasone. The drug costs just £5 for a course. It is still not part of India’s treatment protocol. Currently, the cost of the injection is below Rs 10 in India.

4. Hydroxychloroquine

Hydroxychloroquine (HCQ) was first developed in India for the treatment of malaria. The drug is also a disease-modifying anti-rheumatic drug (DMARD), which helps in reducing swelling and pain in arthritis patients.

? How Hydroxychloroquine works?

An article in The Lancet Global Health said Hydroxychloroquine shows antiviral activity in-vitro against coronaviruses, and specifically, SARS-CoV-2. At approved doses, the drug can prevent SARS-CoV-2 infection and ameliorate viral shedding.

? What is the dose and usage recommended?

Many nations, including India, have been using hydroxychloroquine as a prophylactic drug. The Health Ministry has prescribed the use of hydroxychloroquine to people working on the frontlines (healthcare staff and police personnel) and those who are in direct contact with a Covid-19 positive person.

“This drug should be used as early in the disease course as possible to achieve any meaningful effects and should be avoided in patients with severe disease. An ECG should ideally be done before prescribing the drug to measure QT interval,” the latest Health Ministry guidelines say.

? Which companies are manufacturing HCQ and what are the costs?

At present, 12 manufacturing units in the country are producing hydroxychloroquine, with Zydus Cadila and Ipca Laboratories being the largest manufacturers. Other leading manufacturers of HCQ include Intas Pharmaceuticals, McW Healthcare of Indore, Macleods Pharmaceuticals, Cipla and Lupin. In India, HCQ costs less than Rs 3 per tablet.

5. Plasma therapy

Convalescent plasma therapy or CPT involves the transfusion of the blood plasma of a recovered patient into another patient. The procedure has been used for several diseases earlier, but its efficacy for Covid-19 is still under investigation. The therapy is meant for critical patients with low oxygen saturation levels, or those suffering a cytokine storm. As per the ICMR protocol, preference is given to those at risk of cytokine storm, extreme breathlessness with severe pneumonia.

? How does the therapy work?

Convalescent plasma therapy seeks to make use of the antibodies developed in the recovered patient against the coronavirus. First, the plasma from such people is taken and is then injected in critically ill patients so that the antibodies are transferred and boost their fight against the virus.

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