Used to treat rheumatoid arthritis, #Tocilizumab got the green light because of its ability to lower the inflammatory overreaction of the human immune system, which leads to death in infected patients.
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Earlier this week, India began multi-centre clinical trials of the drug – Tocilizumab for treating COVID-19 following approval from the Central Drugs Standard Control Organisation (CDSCO).
— Dr. Arvinder Singh Soin (@ArvinderSoin) May 11, 2020
What is Tocilizumab? As per recent media reports, it is a second-line drug used to treat moderate to severely active rheumatoid arthritis in adult patients.
Once the COVID-19 virus enters the human body, it infects the lung cells, rapidly multiplies, breaks through these cells and infects other cells.
“In this process, the virus has a unique ability to incite a hyper-response of the immune system. It does so by stimulating the release of certain chemicals called cytokines (mainly IL6), which stimulate inflammation called cytokine storm or cytokine release syndrome (CRS), which in turn causes more tissue damage,” states the note issued by Dr Arvinder Singh Soin, chairman of the Medanta Liver Transplant Institute, Medanta-The Medicity, Gurugram and the National Lead Investigator of the trial, to The Better India.
While the initial tissue damage is directly due to the virus, further damage in the majority of patients who become very ill is due to excessive inflammation or CRS.
“Tocilizumab is an [monoclonal] antibody drug that blocks IL6 and prevents or stops this excessive inflammation. It is already available and proven to be effective in CRS due to other conditions. There are strong indications from early data that its timely use in COVID-19 will stop CRS and prevent severe lung damage, multi-organ dysfunction, need for ICU/ventilation and death,” said Dr Soin, in the note.
He goes onto add that while Tocilizumab is under trials in other countries, their protocols include severely ill patients who may be in too advanced a stage to respond to treatment.
“On the other hand, the majority of our patients will be those who are hospitalised with moderate illness but not at the ICU/ventilator stage. The idea is to prevent them from progressing to the severe stage. This is of vital importance for India where lack of enough ICU beds and ventilators would be a bottleneck once the infection rates rise,” he noted.
And, what are monoclonal antibodies? They are “lab-made proteins that act like natural antibodies and that work by identifying and binding to the virus to destroy it,” says this Hindustan Times report.
As a result, Tocilizumab is emerging as a critical new tool against Covid-19.
Dr. Soin goes on to add that the trials will be carried out in hospitals across 10 cities in states including Maharashtra, Uttar Pradesh, Tamil Nadu, Telangana and the Delhi-NCR region.
Meanwhile, Dr Naresh Trehan, Medanta CMD and Chief Cardiac Surgeon, noted, “In this global war against the pandemic, the most well-intentioned and generous firefighting efforts, while laudable, will exhaust soon. As soon as we reboot, the infection rates will surge. Science is the only way forward. It is imperative that we muster our intellectual and financial resources in finding effective treatments and vaccines. We eagerly await the results of this trial. If it works, it could save thousands in India and have a real global impact too.”
Without a vaccine or drug to specially treat COVID-19, clinicians from across the world are looking towards repurposing existing drugs to identify solutions that are both effective and safe. In the United States, for example, its Food and Drug Administration approved the use of antiviral Remdesvir for emergency use. Late in March, the World Health Organisation began an international clinical trial to help find an effective treatment for COVID-19.
Standing at the forefront are what it thinks four of the most promising experimental therapies. “Based on evidence from laboratory, animal and clinical studies, the following treatment options were selected: Remdesivir [previously tested as an Ebola treatment]; Lopinavir/Ritonavir [licensed treatment for HIV]; Lopinavir/Ritonavir with Interferon beta-1a [which is used to treat multiple sclerosis]; and Chloroquine or Hydroxychloroquine [used to treat malaria and rheumatology conditions],” says WHO.
Based on emerging evidence, said WHO, other drugs will be added.
This is a race against time as the COVID-19 pandemic continues to wreak havoc in India. There are 70,756 total confirmed cases in India while the number of fatalities stands at 2,293 as of today.
(Edited by Saiqua Sultan)