TORONTO — An expert group is recommending Ontario clinicians ration doses of a drug used to treat COVID-19 as a supply shortage coincides with a third wave of infections that’s sending more patients into intensive care.

The scientists advising the province on the pandemic published revised clinical guidelines this week reflecting the shortage of tocilizumab, an anti-inflammatory drug approved in Canada to treat arthritis. A March report from the group found the drug reduced COVID-19 patients’ need for mechanical ventilation and improved chances of survival. 

The COVID-19 science advisory table recommends the drug for critically and moderately ill patients and previously said a second dose could be considered after 24 hours if a patient didn’t improve. This week, its guidance was updated to recommend a fixed dose of 400 milligrams per patient and no second dose.

Dr. Peter Juni, the group’s scientific director, said the dosing change is unlikely to impact patients’ treatment but rationing the drug was recommended so the maximum number of people can benefit.

“It’s basically the best trade-off we can make to treat this population of patients in the hospital who would require the drug,” he said in an interview Thursday. 

The advice comes as Ontario hospitals grapple with higher-than-ever numbers of COVID-19 patients in intensive care units – 523 patients with COVID-related critical illnesses were in the province’s ICUs as of midnight Thursday according to Critical Care Services Ontario.

Recent studies have given more insight into tocilizumab’s effectiveness in treating COVID-19, and such findings have driven the global demand for the drug over the last few months, Juni said.

“It’s only since then that this is becoming a drug that is in high demand because of COVID-19, and it unfortunately coincides with the occurrence of the third wave,” Juni said. 

He said the situation highlights the limited options available to physicians treating COVID-19, with tocilizumab one of two drugs that show a clinical difference in the outcome of a patient’s illness. 

“The point is, we don’t have such a big toolbox,” he said. 

Dr. Andrew Morris, co-chair of the science table’s working group that drafted the new recommendation, said physicians believe the drug reduces inflammation that causes COVID-19 patients to become severely ill, particularly in their lungs. In an ideal world, he said, anyone hospitalized who requires oxygen should receive it.

Both experts said the single-dose recommendation is unlikely to have an impact on patients, with Morris noting that the drug stays in the body for a significant period of time. 

So far, Morris said the most severe supply issues have been reported in Greater Toronto Area hospitals, with some running out of the drug recently. He added that colleagues elsewhere in the province have reported having to make decisions about rationing it to the sickest patients.

The Scarborough Health Network, which operates three hospitals in the Toronto area, noted the effects of the shortage in a statement Thursday. 

“We understand there is a limited supply of tocilizumab and we are beginning to feel the effects of this shortage at Scarborough Health Network,” it said. “This is a fluid and rapidly changing situation, and we are working with other hospitals to secure a short- and medium-term supply as quickly as possible.”

Morris said he’s confident the supply issues with tocilizumab will be resolved, but he noted that it’s just one resource out of many being strained in intensive care units – including hospital staff, equipment and other supplies needed to treat patients. 

“All resources are finite,” Morris said. “Right now, the very apparent strain is on tocilizumab. But it may be something else, and that’s why it’s so important for us to do everything that we can to keep control of cases.”

This report by The Canadian Press was first published April 8, 2021. 

Holly McKenzie-Sutter, The Canadian Press

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