Two drugs have been approved to treat COVID-19 patients in India. Generic versions of Remdesivir and Favipiravir have been approved and launched and while medical experts in India note these are “positive developments in the fight against the pandemic,” they caution that these antivirals are not “game changers.” Pricing has emerged in India. A tablet of Favipiravir (FabiFlu) from Glenmark Pharmaceuticals goes for $1.38 per pill. Generic Indian producer Hetero supplies Gilead’s Remdesivir for $66.92 to $80.30 per dose.
Favipiravir from Japan’s Toyama Chemical (Fujifilm group) has gone generic and now Glenmark Pharmaceuticals has developed Favipiravir under the brand name FabiFlu for the treatment of mild to moderate COVID-19. Meanwhile, Cipla and Hetero have received approvals from the Drug Controller General of India (DCGI) to launch Remdesivir as “Cipremi” and Covifor” for Cipla and Hetero respectively, reports the Hindustan Times.
Nothing Effective Yet
Some health experts have their doubts. Dr. Sanjay Rai, Professor at the Centre for Community Medicine, AIIMS Delhi positions that up to now there are no real effective treatments or vaccine to combinate SARS-CoV-2, the virus behind the COVID-19 pandemic. Dr. Rai commented to PTI, “Till date we don’t have evidence that a particular drug is effective, so we cannot call any drug game changer till then. With their launch, it will only be clear in the future how effective they will be. Whether they can play a supportive role in COVID-19 treatment is also not yet known.”
Also chiming in to PTI (Press Trust of India) on the topic of “game changer” was Dr. Vikas Maurya, Director, Department of Pulmonology and Sleep Disorders, Fortis Hospital, Shalimar Bagh, commenting neither Remdesivir nor Favipiravir are game changers. The doctor acknowledged that these antivirals may help but “It is not as if all those taking these drugs will recover.” He went on to declare, “But yes, it is a positive development as it is better to have something in hand than nothing.” Dr. Rommel Tickoo Associated Director, Internal Medicine Max Healthcare, had similar views as to Dr. Maurya, commenting there have been limited studies on these drugs precluding the term “game changer” but acknowledging their launch as overall a positive development.
But What about Dexamethasone?
Sir Ganga Ram Hospital lung surgeon Dr. Arvind Kumar also agreed that the antiviral drugs to date were not game changers, however he suggested if there was any one game changer it could be dexamethasone which in a clinical trial demonstrated a significant reduction in mortality, is available and economical.
The Indian Generic Market for COVID-19
Gilead has been working behind the scenes to ink deals to distribute Remdesivir in India and elsewhere via generic producers. In India those firms that entered into non-exclusive licensing deals included Hetero, Cipla and Jubilant Life Sciences for the manufacturing and distribution of Remdesivir.
Hetero received approval from DCGI to launch their generic version of Remdesivir, to be available in 100 mg vials (injectable) and administered intravenously in a hospital setting under the supervision of the appropriate healthcare practitioner. According to Vamsi Krishna Bandi, MD, with Hetero Group of Companies, the price point for the generic Remdesivir will be Rs 5,000-6,000 per dose or $66.92 to $80.30 per dose. This of course is part of Gilead’s monetization plan: in the U.S., that number is $3,130 per dose for private insurance and $2,340 for public insurance (e.g. Medicare, etc.).
In the meantime, Glenmark Pharmaceuticals launched their FabiFlu antiviral treatment for patients with mild to moderate COVID-19 based on Favipiravir. The price point: Rs 103 per tablet ($1.38 per pill).
What about Ivermectin in India?
There is active investigation in India with prominent health providers such as Maxx Healthcare conducting an Ivermectin clinical trial led by Sandeep Budhiraja, MRCP, FACP.
TrialSite News has reported a number of health care providers, such as city hospitals, are using Ivermectin, accepting off label protocols. An example would be the use of Ivermectin successfully to treat a 100 -year old man infected with COVID-19 at Mumbai’s Rajawadi Hospital. However, Ivermectin is not approved there and is only the subject of a handful of studies. It is primarily used as a low cost, off label approach to COVID-19 and only in some hospitals. TrialSite News cannot be certain how pervasive the use is in India.