THE government-run Vicente Sotto Memorial Medical Center (VSMMC) on Wednesday, Sept. 1, 2021, said it may sell the anti-inflammatory drug tocilizumab and other investigational drugs being used to treat coronavirus disease 2019 (Covid-19), but only through a hospital to hospital arrangement and as long as there is enough supply.
Tocilizumab is an intravenous drug for rheumatoid arthritis that has been repurposed to treat severe and critical cases of Covid-19. The sharp rise in Covid-19 cases in Cebu since the second half of July has led to a dearth in supply and skyrocketing prices despite a presidential directive regulating the price.
Government agencies mandated to implement the regulatory prices, however, said they could not investigate the alleged overpricing unless a complaint is filed.
Rica Aumentado, Food and Drug Administration (FDA) 7 supervisor, said they will need the exact location and other information pertaining to those who are selling tocilizumab and other drugs used to treat Covid-19 at exorbitant prices.
She said an investigation will be a collective effort of the Department of Trade and Industry and Department of Health (DOH).
“We will work on it. We already talked to the FDA central office. What we need are concrete details,” she said.
VSMMC Covid-19 chief implementer Dr. Helen Madamba said the government-owned tertiary hospital gets its supply of medicines through government procurement.
Madamba said they help other government hospitals in terms of logistics for the management of Covid-19 patients.
“Yes, since hospitals are helping each other during this time of pandemic. It’s just that these supplies are very limited,” she said.
Aside from tocilizumab, other investigational drugs being used for Covid-19 management in the Philippines are remdesivir and dexamethasone.
“We emphasize that these are considered ‘investigational drugs for Covid-19’ that should be given only as inpatient (while admitted in the hospital) under the supervision of a doctor, considering potential serious adverse reaction,” the VSMMC said in a statement.
Tocilizumab, which is available in a 200mg/10mL vial and 400mg/20mL vial, is given at a maximum of two doses.
Remdesivir, an antiviral drug originally developed to treat ebola, is injected at one vial per day for five to 10 days, or a maximum dose of 11 vials including the loading dose.
“Remdesivir and tocilizumab are investigational drugs for Covid-19 and should be administered only for admitted patients under the close supervision of doctors and Covid-19 pharmacists,” VSMMC said.
“Since VSMMC caters to critical, severe cases, we ensure stock level of these medications should always be made,” it added.
Dexamethasone, which is also used to treat inflammation, is given in a 6mg ampoule once daily for up to 10 days.
Azithromycin, an antibiotic given for bacterial infections such as pneumonia, is given at one tablet daily up to 10 days.
Considering full treatment, one patient would need a maximum of 11 vials of remdesivir, two vials of tocilizumab, 10 ampoules of dexamethasone and 10 tablets of azithromycin, the VSMMC said.
The Cebu City Emergency Operations Center (EOC) on Wednesday sought the help of the Department of Trade and Industry (DTI), DOH Central Visayas, Presidential Assistant for the Visayas Michael Lloyd Dino and FDA in implementing regulations imposed on Covid-19 drugs.
Councilor Joel Garganera, EOC deputy chief implementer, said the prices of these medicines have gone up.
He said a 400mg/20 ml vial of tocilizumab cost P130,000 in August from P75,000 in July while the price of remdesivir went up to P6,000 in August from P4,000 in July. The price of favipiravir (200 mg/40 tabs) increased to P12,000 in August from P10,500 in July.
“It is the request of the Cebu City EOC that the prices of these life-saving medications be regulated accordingly so as to prevent hoarding and give a fighting chance for Covid-19 patients of surviving this disease,” wrote Garganera in the letter.
The prices of tocilizumab, remdesivir, dexamethasone and favipiravir are regulated, with the DOH setting suggested retail prices for each.
On Sunday, the National Kidney and Transplant Institute in Quezon City, a government-owned and -controlled corporate tertiary specialty center attached to the Department of Health, announced that it would suspend the dispensing of remdesivir and tocilizumab as these drugs had reached “critical stock level” at its pharmacy amid the surge in the Covid-19 patients that it was handling.
In a media briefing Tuesday, Health Undersecretary Ma. Rosario Vergeire acknowledged challenges in sourcing tocilizumab amid stiff competition from other countries.
Earlier, on Aug. 18, the World Health Organization and global health agency Unitaid expressed concern over Roche’s statement on Aug. 17 warning of a global shortage of tocilizumab for the next few weeks as global demand surges amid rising Covid-19 cases driven by the highly transmissible Delta variant.
They called on Roche to “ensure equitable allocation of current stocks of this medicine for all countries, including low- and middle-income countries.”
“We also strongly encourage Roche to facilitate technology transfer and knowledge and data sharing to broaden access to this important treatment,” WHO and Unitaid added.
Genentech, a member of the Roche Group, announced Aug. 17 that it was experiencing an unprecedented demand for its tocilizumab sold as “Actemra IV--well over 400 percent of pre-Covid levels over the last two weeks alone and it continues to increase.” (WBS, JOB, JJL, CTL)