PUNE: The Centre’s Joint Task Force has clarified that conventional amphotericin B is ‘equally efficacious’ as its more expensive version in the treatment of Covid-associated mucormycosis.
The task force advisory brings massive relief to patients nationwide.
Most doctors treating mucormycosis have been apprehensive about using conventional amphotericin (deoxycholate), citing its impact on the kidneys by triggering nephrotoxicity.
Instead, they have been insisting on the extremely expensive (liposomal) formulation of the drug.
But a minimum 21-day course of the liposomal form can cost anywhere between Rs 7.5 lakh to Rs 17 lakh, depending on a patient’s body weight.
Treatment with conventional amphotericin (deoxycholate) for the same period only costs about Rs 8,000 to Rs 16,000.
The task force experts said conventional amphotericin B can be administered without worry, as long as doctors monitor patients’ kidney functions and electrolytes imbalance.
The Joint National Task Force for Covid-19 is an expert body of the NITI Aayog and the ICMR.
“The Joint National Task Force has recommended that amphotericin B — both in the amphotericin B lipid complex/liposomal form and the amphotericin B deoxycholate form — is equally efficacious for the treatment of Covid associated mucormycosis (CAM) cases,” Union health secretary Rajesh Bhushan said in a letter to states and union territories on June 7, 2021.
The health ministry has requested states and UTs to widely disseminate the advisory among doctors across public and private hospitals.
In a June 7 report, TOI had said that administering conventional amphotericin, along with careful monitoring of kidney functions, can reduce mucormycosis treatment cost by 100 times and make it affordable for the masses.
The liposomal form of amphotericin injections cost the patient Rs 35,000 per day.
The conventional form of the drug (deoxycholate) costs just Rs 350 per day, but needs a blood test every alternate day to rule out the drug toxicity in the kidneys.
Infectious diseases expert Sanjay Pujari, member of the national task force, said, “Use of conventional amphotericin does not cause long-term kidney complications.
All minor kidney issues, post-conventional amphotericin therapy, are fully reversible.” Medical experts noted that an “unwarranted fear” of conventional amphotericin causing kidney damage has led to the hyped demand for the liposomal form.
“It is the fear of ‘kidney damage’ in the minds of the public as well as treating physicians that has led to the overrating of the liposomal form.
We should dispel this fear.
Careful and regular monitoring with blood creatinine and few other tests can tide over this risk and make use of conventional amphotericin effective,” said ENT surgeon Samir Joshi.
Joshi, who is the head of department of ENT at the state-run B J Medical College and Sassoon General Hospital, has treated about 201 patients with post-Covid mucormycosis.
“More than 85% of these patients recovered through monitored use of conventional amphotericin and carefully planned debridement surgeries,” he said.