Amidst the increasing demand and depleting supply of Injection Remdesivir for very sick COVID19 patients, doctors in J&K and across India have warned against the misconceptions and abuse of the drug, underlining it has limited role in management of SARS-CoV2 infection.
Earlier this month, the World Health Organisation delisted Remdesivir as a drug meant for treatment of COVID19. Dr Saumya Swaminathan of WHO has said that "findings from five clinical trials in the past show that the use of the antiviral drug has not helped in curtailing mortality or reducing the need for mechanical ventilation among hospitalised COVID-19 patients". She said there was no proof that the drug, which has been widely used for the past one year for treatment of SARS-CoV2 infection reduced the duration of hospital stay or reduced the death rate.
Despite this, patients have been struggling for the doses of Remdesivir for family members admitted across hospitals in J&K. The drug continues to be prescribed across the hospitals of India.
Prof Parvaiz A Koul, senior physician and influenza expert who till recently served as head of Internal Medicine at SKIMS Soura said doctors and people need to know and understand that Remdesivir is not a "magic wand". "It may help in reducing symptoms and stay in some patients, in combination with steroids. Please note the word 'may' that I use," he said. He said that in the most quoted study published in New England Journal of Medicine (NEJM) earlier last week, it reduced hospital stay by 4 days but there was no significant mortality benefit at day 29. "It is not recommended in non-hospitalized patients and even the latest AIIMS guidelines for COVID19 management, it has been listed for use on off label," he said.
It has to be used in only moderate to severe disease, preferably within 10 days of the onset of symptoms. Patients not requiring oxygen or in home care should not be put on this drug. "It is a dangerous practice," he said. He said it was being used because the arsenal against COVID19 was limited and all kinds of combinations were being tried. However, he said, with newer studies emerging and clarifying its efficacy, doctors must prescribe wisely.
A senior infectious diseases expert managing COVID19 at SKIMS Soura said that hospitals need oxygen, antibiotics, steroids and anticoagulants. He said Azithromycin, Levofloxacin, Doxycycline, Ivermectin, Remdesivir and Toclizumab are over prescribed. "They have no scientific benefit as COVID19 has no specific antiviral treatment till now," he said.
He said that doctors were misusing the drug and triggering a pharma-malpractice. "They are paving way for black-marketers and hoarders while the patients run from pillar to post," he said. In the recent past, many families have issued appeals for helping them get Remdesivir for admitted members. Many, as per doctors, get it from black market as well.
There is a scarcity of Remdesivir in Kashmir hospitals as the drug continues to be in high demand across India. Managing Director of JKMSCL, the corporation that procures drugs for J&K health sector said due to the demand, J&K was getting "daily supply" and had no reserves of the drug.