Severely ill Covid-19 patients fared better when they received remdesivir and tocilizumab, the two experimental drugs administered individually or in combination, than those who did not get them, observed doctors from KEM Hospital, a premier medical college and hospital.
The survival rate in patients receiving either or both the drugs was 64%; it dropped to 34% among those who did not get any of the two. In the group that benefited, the rate of discharge among those given remdesivir alone was 66%, for those who got only tocilizumab it was 80%, and 47% among those given both the drugs combined.
The doctors studied the effect of remdesivir and tocilizumab on 521 patients at the KEM Hospital and compared it with retrospective clinical details of 214 patients from a time when they were not available as experimental drugs for Covid (from 23 March to 31 May 2020).
Of the 334 (64%) patients discharged after being given either or both the drugs, only five needed supplemental oxygen. The doctors’ observational study was published on 1 July in the Journal of the Association of Physicians of India.
The doctors found that hospitalisation (median days) was maximum in the tocilizumab group — 47 days. It was 14 days in the remdesivir group and 10 in the group receiving both drugs. Patients requiring vasopressors, medicines that help in tightening blood vessels and raising blood pressure, had higher mortality, said Dr Vishal Gupta, associate professor, intensive care, department of medicine, from the hospital and also the principal investigator of the study.
“The study observed that patients below 55 years are around three times more likely to get discharged. The chances of patients with face masks or nasal prongs surviving are 34 times higher than the ones on invasive ventilation,” said Dr Sushrut Ingawale, a third-year resident, who worked on the study with Dr Amit Bhondve, Dr Wasim Khot and nine others.
However, most of these factors were not true for the tocilizumab group. “We observed that tocilizumab if given at an appropriate time to the right patients, can help in improved survival and less need for mechanical ventilation. In old and fragile patients, it did not seem to have a similar outcome. For instance, the drug may not improve outcomes for patients who already have a secondary infection,” said Gupta.
“Our study states that these drugs can give better clinical outcomes, but a larger multi-centric trial is needed,” added Ingawale.
Being a tertiary care hospital, KEM mostly received critical patients. The researchers classified the 521 patients in three randomised treatment groups based on the availability and supply of the two drugs between 1 June and 30 September 2020, and compared it with a fourth group, admitted to the ICU when these drugs were not available. More than half the patients were above 55, male (62%), with diabetes (41.8%) and hypertension (42.4%) as the most common comorbidities.