Experts ponder over plasma but calls grow for trials of all Covid drugs

New Delhi: After the Indian Council of Medical Research dropped the use of convalescent plasma therapy for treating mild Covid-19, there are now renewed calls for extensive clinical trials for other drugs used for Covid-19 patients, even as doctors in Delhi stand divided on the use of plasma therapy.

While some private hospitals are continuing to prescribe it despite little to no evidence of its efficacy, leading to patients' kin running from pillar to post for donors, many other hospitals say they are being very careful in recommending plasma therapy.

And amid this, many have called for drugs such as Ivermectin and hydroxychloroquine (HCQ) for mild COVID-19 treatment - both of which continue to be recommended by the ICMR for treating certain cases.

This has surprised many doctors across public hospitals in Delhi because they say both drugs have a "low certainty of evidence" and even the ICMR guidelines classify them as such.

Internal medicine expert Dr Suchin Bajaj said that even other drugs such as Favipiravir, Tocilizumab do not have had very conclusive clinical trials and might be being prescribed to more people than required. He went on to say that trials for Tocilizumab had failed and that Faviparivir did not have trials at all.

Moreover, Dr Bajaj said these are just some examples of drugs that might not be safe but are still on the list of approved medications for Covid. Many doctors in public hospitals concurred. One senior doctor at AIIMS said that they were surprised that both Ivermectin and HCQ continue to be prescribed across the city.

"Till now, there have been no trials that have proven the effectiveness of any drug in managing critical COVID-19 patients except for steroids, specifically dexamethasone (WHO Solidarity trial). Data on effectiveness of various drugs, Remedesivir, Hydroxychloroquine, Tocilizumab, and Favipiravir) is sketchier than data on plasma therapy", Dr Bajaj added.

But even as the consensus calls for clear evidence-based randomised control trials for all COVID-19 treatment drugs/methodologies, plasma therapy's departure from ICMR's list has been welcomed.

And this comes with the nuance that plasma could still be effective in a very small window. Dr Bajaj explained that many missed this window because by the time they get their Covid reports and consult a doctor, they already miss it.

Dr Prateek Goel, senior resident at Lok Nayak hospital (LNJP), which maintains one of the largest government-run plasma banks in Delhi, apart from Institute of Liver and Biliary Sciences (ILBS) and Guru Tegh Bahadur hospital (GTB), agrees that timing is of the essence.

And despite recommending only in selective cases within the window, he said, "It has been effective for one out of 10 patients. That's why we have been using plasma therapy selectively, and now that ICMR has removed it from clinical management guidelines, it's likely to go down considerably."