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Anti-rheumatic drug reccommended for steroid non-responsive COVID19 patients, revised clinical guidelines
Rohit Shishodia
Tocilizumab may be considered in rapidly progressing COVID19 patients who need intermittent oxygen supplementation (IMV) and do not respond adequately to steroids (preferably within 24-48 hours of the onset of severe disease or ICU admission), the Union Health Ministry said in revised guidelines of Clinical Guidance for Management of Adult COVID19 Patients.
Tocilizumab is an immunosuppressive drug that is used to treat rheumatoid arthritis and systemic juvenile idiopathic arthritis, a severe form of arthritis in children and is a humanised monoclonal antibody against the interleukin-6 receptor.
The guidelines emphasised that the drug should preferably be administered with steroids and for patients who do not have any active TB, fungal, systemic bacterial infection.
"The drug may be considered in long term follow-up for secondary infections (such as reactivation of TB, Flaring of Herpes etc.) and significantly raised inflammatory markers (CRP and/or IL-6)," the ministry added.
The recommended single dose is four to six mg/kg body weight (400 mg for a 60 kg adult) diluted in 100 ml normal saline solution and administered over one hour through intravenous route.
The ministry said that another drug-Remdesivir-may be considered for patients within 10 days of onset of symptoms, in those having moderate to severe disease (requiring supplemental oxygen), but who are not on intermittent mandatory ventilation (IMV) or extracorporeal membrane oxygenation (ECMO), where blood is pumped outside the body to a heart-lung machine that removes carbon dioxide and sends oxygen-filled blood back to tissues in the body.
The ministry said that the drug should also be considered for five days to treat hospitalised patients with COVID19 (No evidence of benefit for treatment more than 5 days).
The drug should not be used in patients who are not on oxygen support or in-home settings. The recommended dose: 200 mg IV on day one followed by 100 mg IV OD for the next four days, the guideline stated.
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