No doubt, covid-19 has led to a plethora of investigational new drug trials – to curb the threat of a pandemic, and tocilizumab is one such drug that has gained traction for its ability to reduce mortality among patients with moderate, severe, or critical covid-19. However, tocilizumab costs anywhere between seven and ten million Uganda shillings for a single dose. I bet only a handful of Ugandans can afford it. It is one of the covid-19 wonder drugs that you may never prescribe as a clinician or use as a patient. In today’s article, we highlight what tocilizumab is.
As the news of a novel coronavirus from Wuhan in China hit the tympanic membranes of many scientists across the globe, they switched on their turbo modes to analyse the virus. Various clinical trials led to a plethora of research findings: most of them led to groundbreaking discoveries. Others buried the myths about the efficacy of a few generations old drugs that had gained traction. Low-dose dexamethasone for the former: hydroxychloroquine for the latter. Through such trials, emanated vaccines at such rocket speeds that vaccine development technology achieved a whole new level. Because the level of inflammation (cytokine storm) dictated the severity of the disease, it became more prudent than ever to engineer a drug that specifically targeted one of the inflammatory molecules to curb the inflammatory cascade down. Tocilizumab became of the fruits of such hard work.
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One of the notorious pro-inflammatory molecules involved in the cytokine storm is interleukin-6 (IL-6). Tocilizumab, a monoclonal antibody, inhibits the IL-6 pathway by blocking the IL-6 receptors and thus blocks the inflammatory cascade. Several clinical trials have shown that tocilizumab reduces mortality among patients with moderate-to-severe, severe, and critical covid-19. According to various clinical guidelines, such patients have evidence of worsening disease. At 8mg/kg, patients receive tocilizumab as a single dose (UpToDate).
Even when you, your patient, or your relative meets the criteria for receiving the drug, you (they) may not be able to get it due to its exorbitant price. The price per dose ranges from seven to ten million, and only a few Ugandans can afford such treatment. And it won’t be enough: you will need to add the hospital costs that have already reached the roof. And then, we don’t guarantee your healing – God retains that power.
That said, it becomes imperative that you strictly adhere to the SOPs because they are affordable for every Ugandan. You will argue that only a handful of patients with covid-19 succumb to the disease. Well, as right as it sounds, they are only a handful if none of them is either your friend or relative. Be smart, be safe: be responsible.