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2-DG is in the news and there is a quite some conflicting information around it. Let us try and make some sense of it. #2DGDrug
2-DG is in the news and there is a quite some conflicting information around it. Let us try and make some sense of it. #2DGDrug
2-DG is short for 2-deoxy-D-glucose, a drug developed by DRDO (Defence Research and Development Organisation) in collaboration with Dr.Reddy’s Laboratories (DRL).
2-DG is a generic molecule, a synthetic analogue of glucose. It is said to selectively accumulate in SARS-CoV-2 infected cells, cutting off the glucose supply, reducing energy production and stopping further viral synthesis.
Image: Moleculin website
Image: Moleculin website
On May 1 2021, 2-DG has been granted emergency approval by the DCGI (Drug Controller General of India) to be used in moderate to severe cases of Covid19.
History: 2-DG is not a new drug. It was proposed for cancer therapy as early as 1954 in US. In 2004, this drug underwent Phase 1 clinical trials in US for cancer treatment. This molecule functions as a glucose decoy & can differentiate between normal cells & cancer cells.>>
>>2-DG was claimed to starve the cancer cells by blocking their access to glucose. However, the extent of anticancer effect found in the lab was not seen in human trials as it was rapidly metabolised as soon as it entered the human body.
Why the renewed interest in 2-DG in Covid19 treatment?
It was chosen for trials based on its inhibition of SARS-CoV-2 from the lab studies conducted by Institute of Nuclear Medicine & Allied Sciences (INMAS) and DRDO.
It was chosen for trials based on its inhibition of SARS-CoV-2 from the lab studies conducted by Institute of Nuclear Medicine & Allied Sciences (INMAS) and DRDO.
Clinical trials: Phase II clinical trials happened between May 2020 and Oct 2020 on a total of 110 patients. ctri.nic.in/Clinicaltrials…
Phase III clinical trials had enrolled 220 patients across 26 sites in the country and ran from Dec 2020 to March 2021. ctri.nic.in/Clinicaltrials… >>
Phase III clinical trials had enrolled 220 patients across 26 sites in the country and ran from Dec 2020 to March 2021. ctri.nic.in/Clinicaltrials… >>
>>The CTRI website does not mention the exact parameters the trial set out to measure.
Apart from the preliminary data on the CTRI website, there is no preprint or paper published in any peer reviewed medical journals on the trial results in treatment of Covid19.
Apart from the preliminary data on the CTRI website, there is no preprint or paper published in any peer reviewed medical journals on the trial results in treatment of Covid19.
The summary of the trials in a press release on the Ministry of Defence website states that 2-DG results in faster recovery of hospitalised patients + reduces the need for supplemental oxygen, both of which are critical when hospital beds and oxygen is in severe short supply.
The press release clearly indicates that 2-DG is to be used as adjunct therapy, and not as primary therapy.
It has to be prescribed by the treating doctor along with the other drugs as per the protocol depending on the severity of the disease in the patient.
It has to be prescribed by the treating doctor along with the other drugs as per the protocol depending on the severity of the disease in the patient.
Compared to some of the other drugs being used in the treatment of Covid, 2-DG has the advantage of being easily and cheaply manufactured. The dosage needs to be administered in powder form with water.
The latest treatment protocol released by ICMR has not yet listed 2-DG as an add on therapy in moderate and severe cases, so it needs to be seen when doctors will start prescribing it.
It will be available commercially starting June 2021. Pricing is yet to be finalised.
It will be available commercially starting June 2021. Pricing is yet to be finalised.
To summarise:
1. In a pandemic, research institutions have to try their best to come up with quick solutions.
2.Emergency approvals are the need of the hour but so is transparency.
1. In a pandemic, research institutions have to try their best to come up with quick solutions.
2.Emergency approvals are the need of the hour but so is transparency.
3 ."A lot of drugs which look promising in small studies eventually don't pan out to be really effective for Covid-19. We must exercise caution while interpreting data from small studies unless the signal is so strong"-very important point made by pulmonologist Dr. Lancelot Pinto
4. Phase IV trials in the post-marketing phase must collect the pharmaco-surveillance data from the patients in whom it is used over the next few months.
5. This will give a better idea of its safety profile, efficacy and specific clinical endpoints>>
5. This will give a better idea of its safety profile, efficacy and specific clinical endpoints>>
>> which are not released in any public domain yet.
6. This data will be very useful in deciding if 2-DG does have an important role to play in the treatment of moderate to severe Covid-19 cases in the upcoming waves of the pandemic.
6. This data will be very useful in deciding if 2-DG does have an important role to play in the treatment of moderate to severe Covid-19 cases in the upcoming waves of the pandemic.
7. The problem with using social media buzz and internet clickbait to evaluate a treatment is that people don't realise that pure, peer reviewed publications and transparent double blind trials are the ONLY WAY to do medicine. The rest is irrelevant. [end] #2DGDrug #COVID19India
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