Indore: In what is claimed to be a first in the country, doctors at Indore’s Sri Aurobindo Institute of Medical Sciences (SAIMS) have started treating Covid-19 patients with tocilizumab (TCZ), an immunosuppressant mainly used to treat rheumatoid arthritis.
A 100-member team of doctors, nurses and paramedical staff has been treating over 350 Covid-19 patients at the 1,156-bed private hospital in the Madhya Pradesh city. In an interview to ThePrint, pulmonologist Dr Ravi Dosi, who is leading the team, said the tocilizumab therapy has been used on five critical patients, two of whom have made a drastic recovery.
“We have a few middle-aged patients on whom this has yielded good results. In India, as far as I know, no centre has done it. We have evidence from Wuhan and in the States (US), there was an unpublished study too,” Dosi said.
This therapy, he said, was administered in cases where the conventional treatment, including doses of hydroxychloroquine, steroids, oseltamivir, higher antibiotics and ventilatory support, had failed.
The number of cases in Indore was recorded at 897 Monday with 52 deaths, according to data from the office of the district’s Chief Medical and Health Officer.
How it works
Tocilizumab therapy is used against a cytokine storm, which is what causes mortality in several Covid-19 patients. A cytokine is a type of protein secreted by the immune system that helps to ward off infection. A problem occurs when they are produced in excess, leading to ‘cytokine storm’.
“Your body is up in arms against the virus, so much so that it starts harming its own cells. This is what actually causes mortality in corona — the response to the infection becomes so uncontrolled that ultimately we end up losing ourselves,” Dosi said.
A study conducted in The Lancet said the hyperinflammation caused by the cytokine storm should be treated in order to reduce mortality. The TCZ treats critically ill patients by fighting off these cytokines.
“This antibody helps in that particular phase of the disease and if we give it appropriately we can save a lot of patients,” said Dosi.
The treatment was first administered in the hospital on 10 April to a patient in their late 40s. His situation, Dosi said, improved in a week during which the dose of TCZ was administered in an interval of two days. The second patient who improved because of the treatment is a diabetic patient in his early 50s, said the doctor.
The TCZ’s effects on the three other patients are still being studied as they underwent the treatment only recently, added the doctor.
Deciding on treatments
Dosi said an 11-member task force of senior state leaders, temporarily formed to help the Madhya Pradesh government to tackle the situation before the one-man cabinet is expanded, regularly discusses treatment protocols.
According to guidelines floated by the task force, the TCZ treatment should be considered in grade 3 patients with “rapidly worsening respiratory status…” The guidelines also prescribe different doses based on the age and weight of the patients.
“My colleagues and professors here are also sitting down in the morning and evening to discuss the treatment protocols. We are modifying (the treatment strategy) as per our experience on a daily basis,” he said.
The TCZ treatment has been used in China, the initial epicentre of the infection. A study conducted on 15 Covid-19 patients found that multiple doses of TCZ were effective in treating critically ill patients. A clinical trial of this treatment is also under way in the US by one of the world’s largest biotech company, Roche Pharma.
According to Dosi, the main issue in treating Covid-19 is the rapid deterioration it causes in patients’ condition. “I can quote from the experience of one of my patients only. One of his brothers fell ill and succumbed to the disease on the fourth day,” he said.
The other complication the doctors face is in treating patients with comorbidities. The doctors at the hospital keep a close watch on their older patients who have comorbid conditions like cardiovascular diseases. SAIM’s Intensive Care Unit currently houses 50 such patients.
“Apart from the standard protocol for Covid-19 pneumonia [symptoms] prescribed by All India Institute of Medical Sciences, Delhi, we are taking care of the other ailments like hypertension, diabetes, and strict sugar control by monitoring their cardiovascular function. There is a full team of anesthetists, pulmonologists, who are monitoring these critical patients for 24 hours,” he said.
For now, the team is administering hydroxychloroquine (HCQ) in some patients with a lot of care — electrocardiogram or ECG tests are performed before the drug is prescribed.
Dosi, however, described the HCQ as only a “glimmer of hope”. “It is not an absolute therapeutic drug, because it increases the penetration of the virus into the part where it is destroyed. It has an additive effect but it is not the treatment of choice,” he said.