Observational Study of Covid-19 Cases and Off-label Drugs to Manage Complications during First and Second Wave

Background: Initially Covid-19 complication treatment was almost nil and focused only on supportive measures. Various off-label drugs were utilized globally to obtain better outcomes; the same was practiced by the Indian healthcare fraternity. We have aimed to review the utilization of off-label medicines like Vitamin C, Azithromycin, Ivermectin, Doxycycline, Low Molecular Weight Heparin, Zinc, Remdesivir, Dexamethasone, etc. prescribed in Covid-19 nodal hospital of Telangana state, India.

Methodology: A retrospective review and prospective observational study were conducted in the Covid-19 units of Gandhi medical college and hospital, Secunderabad between December 2020 and May 2021. The study was conducted after obtaining the necessary permission. In a retrospective review; previously published reports were analyzed to correlate the off-label medicine prescription for Covid-19 complications. Prospective case analysis was performed to access the outcome of drugs prescribed in Covid-19 complication and identified as off-label.

Results: A total of 60 prescriptions were analyzed. Among these; Vitamin-C, Dexamethasone, and Azithromycin were prescribed in 67%, 43%, and 37% cases respectively. The study further revealed that hypertension and diabetes mellitus were the two most commo comorbidities that lead to hospitalization and subsequently required aggressive treatment to manage the Covid-19 related complications. Bilateral pneumonia was the most frequently appearing complication and therefore Dexamethasone and Azithromycin were listed as top off-label drugs to manage the same.

Conclusion: Due to the lack of specific treatment available initially to manage Covid-19 complications, off-label medicines not only aided enormously in recovering from the complication but also demonstrated to the world that the right choice of off-label medicine can greatly reduce the risk.