PESHAWAR: An anti-inflammatory drug “Actemra” pioneered by Khyber Pakhtunkhwa for treatment of Covid-19 patients two months ago is showing better results but is not recommended for all those infected with the virus, according to physicians.

The Khyber Pakhtunkhwa government purchased the drugs for free medication of Covid-19 patients but physicians said it was not for all patients and should be given only to selected ones with strict adherence to the guidelines.

“We have administered it to six patients so far. We did see short term response in all of them and there was a reduced speed of clinical decline. Eventually, two progressed again and went on a ventilator, while the remaining four are making a steady recovery,” Dr Awais Naeem, assistant professor of medicine department at Khyber Teaching Hospital, told Dawn.

He said that although the study population was small, the results were promising so far.

Physicians say Actemra is not recommended for all infected people

“It is a drug, which can be of potential benefit in properly selected patients if given in a setup with good intensive care backup,” he added.

Actemra is a biologic medication, which is a protein designed to affect the immune system and is often prescribed for severe inflammatory arthritis in adults and children.

Dr Awais said that in coronavirus infection, patients could have a severe inflammatory response to the virus that caused damage to the lungs and other organs. It only has the potential to decrease the inflammation that is caused by or in response to this virus, hence limiting the damage that it can inflict.

“It is given as an infusion and its doses can vary from 400 to 800 milligram. One patient can receive up to two doses, depending on his/her response to treatment,” said the physician.

He said that it was not fit for all but only for selected patients, whose clinical condition was progressively declining and they had a high level of inflammatory proteins in the blood.

Research so far has shown that this drug decreases inflammatory proteins significantly and improves the chances of patient recovery.

“In simple words, it will decrease harmful proteins, prevent organ damage and halt the progression of the disease. At the same time, the body tries to clear the virus and slowly recover from its ill effects,” said Dr Awais.

Adverse effects go side by side with the beneficial effect and when a drug is interfering with the immune system, the potential to cause harm is high. As the drug will be administered to a critically ill patient, there is a risk of acquiring another severe viral or bacterial infection.

Dr Awais said that as Pakistan was endemic tuberculosis area, many patients had hidden inactive tuberculosis inside their system and that drug could lead to its reactivation. It has been associated with liver and intestinal side effects as well.

It is very important that the drug is administered according to the protocol to the selected patients and they should be monitored for potential side effects.

“But often in a critical situation, it will always be risk versus benefit. If we choose a patient correctly, the potential to have beneficial effects is more than its harm,” said the physician.

“We have purchased a big share of what was available with the company. It’s a costly drug, about Rs29,000 per vial of 200 mg. Patients are getting it free of cost,” Director-General Health Services Dr Tahir Nadeem Khan told Dawn.

He said that they were providing the drug to Hayatabad Medical Complex (HMC), Khyber Teaching Hospital (KTH), Lady Reading Hospital (LRH) and all public sector hospitals.

Dr Zafar Iqbal, assistant professor at pulmonology ward of LRH, said that it was not a miracle drug, used widely and patients were getting treated if given in line with the prescribed guidelines.

He said that there were different opinions about its efficacy, some approved while other opposed it, but in many cases, it was found effective. He appreciated the LRH administration for making it available to patients free of cost.

“Today, I advised it to a patient and it was provided to him free of cost. Before its availability in the hospital stores, people purchased it from the market but now it is available. We administer it in line with protocols. We have given it to several patients, who were fulfilling the criteria,” said Dr Zafar.

Published in Dawn, June 2nd, 2020