Mumbai: Amid shortage of Tocilizumab, experts question its efficacy

Health workers conduct tests in Kurla on Wednesday. Pics/Sayyed Sameer Abedi

Amidst a shortage of Tocilizumab, a drug considered to be one of the supportive treatments for COVID-19, experts have started to question its efficacy. While relatives of patients are extremely worried about its unavailability, members of the COVID task force and doctors feel that Tocilizumab has limited effects and Itolizumab, a similar drug, priced at one-fourth the former, is more effective.

Speaking to mid-day, Dr Om Srivastava, infectious diseases specialist and member of the COVID task force, said that he had seen positive results in 20 patients he administered Itolizumab to. "It is a far more effective option. While Tocilizumab has a unimolecular directional approach, Itolizumab has consistent effects on several sites at the same time," he said.

'To be used judiciously'

Dr Shashank Joshi, a member of the task force said that doctors had been asked to use Tocilizumab judiciously and not give more than one or two doses to each patient. "These drugs are experimental and the therapy keeps changing. Current research shows that Tocilizumab is not a life-saving drug and more trials are underway. There are other alternatives like steroids, plasma and Itolizumab, which have life-saving potential. Itolizumab is a slightly better molecule and there is no shortage of it since it is manufactured by an Indian company," he said, adding unlike Tocilizumab, there had been trials of Itolizumab in KEM and Nair hospitals, which yielded positive results.

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Swab samples being collected at a building in Match Factory Lane, Kurla West

"Itolizumab has to be given very slowly along with steroids. If it is given too quickly then it causes infusion infection," said Dr Joshi.

'No trials to compare'

While senior intensivist and task force member Dr Rahul Pandit recommended that only a single dose of Tocilizumab should be given, Dr Kedar Toraskar, another task force member, said, "Indiscriminate use of the drug should not be done since it can lead to secondary infections. Itolizumab can be an alternative provided it fits the needs of the patient but there has been no head-to-head trial to compare the two."

Speaking about the trial that was conducted at Nair hospital, dean Dr Mohan Joshi said 200 patients at the hospital had been given Itolizumab. "All those who received it have done well and it is a wonderful drug. It is effective on a broader scale and in some ways, is better than Tocilizumab," he said, adding that private doctors don't prescribe it as much, since it is made in India, and they prefer an international drug. Meanwhile, relatives of patients have been complaining about the unavailability of Tocilizumab as Cipla has stopped supplying it to distributors. Wasim Syed, 40, whose father-in-law was admitted to Prince Aly Khan Hospital on August 13, said, "We looked for the drug at Masina Hospital, pharmacies in Bhiwandi and even in Pune but could not find it. The doctor then started a different line of treatment and his condition is better now. Hospitals should prescribe medicines that are available. Why cause panic when they know we won't find it."

Last month, Roche, the company manufacturing Tocilizumab, had said that their trial didn't find the drug to be effective when used on COVID-19 patients. After that Cipla stopped supplying it to distributors.

'Fresh stock expected'

Hukumraj Mehta, president of Maharashtra State Chemist and Drug Association said that a fresh stock of Tocilizumab was expected next week. "The shortage has been affecting the entire country for the past two weeks since Cipla is the only supplier. I have been told that Cipla is currently out of stock and a fresh batch is expected on August 24 after which we will get the supply," he said.

Rs 6,000-7,000
Cost of a single vial of Itolizumab

Rs 40,000
Cost of a single vial of Tocilizumab

200
No. of patients at Nair hospital who has been given Itolizumab

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