2-deoxy-D-glucose (2-DG), an indigenously developed anti-COVID drug was officially launched yesterday by the Defence Minister Rajnath Singh and the Union Health Minister Dr Harsh Vardhan. The first batch comprising of more than 10,000 doses of the drug was released.

2-DG has been developed by Defence Research and Development Organisation (DRDO)’s Institute of Nuclear Medicine and Allied Sciences (INMAS) and Dr Reddy’s Laboratories (DRL), Hyderabad.

The drug has gone through the three phases of clinical trials. Published data for the trials is not yet available; however, as per the Ministry of Defence press release dated 8^th May, 2021, “Clinical trial results have shown that this molecule helps in faster recovery of hospitalised patients and reduces supplemental oxygen dependence. Higher proportion of patients treated with 2-DG showed RT-PCR negative conversion in COVID patients.” 

• “INMAS-DRDO scientists conducted laboratory experiments with the help of Centre for Cellular and Molecular Biology (CCMB), Hyderabad and found that this molecule works effectively against SARS-CoV-2 virus and inhibits the viral growth.

• In Phase-II trials (including dose ranging) conducted during May to October 2020, the drug was found to be safe in COVID-19 patients and showed significant improvement in their recovery. Phase IIa was conducted in six hospitals and Phase IIb (dose ranging) clinical trial was conducted at 11 hospitals all over the country. Phase-II trial was conducted on 110 patients. In efficacy trends, the patients treated with 2-DG showed faster symptomatic cure than Standard of Care (SoC) on various endpoints. A significantly favourable trend (2.5 days difference) was seen in terms of the median time to achieving normalisation of specific vital signs parameters when compared to SoC.

• The Phase-III clinical trial was conducted on 220 patients between December 2020 to March 2021 at 27 COVID hospitals in Delhi, Uttar Pradesh, West Bengal, Gujarat, Rajasthan, Maharashtra, Andhra Pradesh, Telangana, Karnataka and Tamil Nadu. The detailed data of phase-III clinical trial was presented to DCGI. In 2-DG arm, significantly higher proportion of patients improved symptomatically and became free from supplemental oxygen dependence (42% vs 31%) by Day-3 in comparison to SoC, indicating an early relief from Oxygen therapy/dependence. The similar trend was observed in patients aged more than 65 years.” 

Salient features of 2-DG

• Glucose analogue 
• Indication: DCGI approved for emergency use as an adjunct therapy in moderate-to-severe COVID-19 cases.
• Formulation: Powder (sachet) taken orally by dissolving it in water for 5-7 days as reported.

• Mechanism of action: A unique characteristic of this drug is its selective accumulation in virally infected cells. By accumulating in the virus infected cells, it prevents virus growth (multiplication) by stopping viral synthesis and energy production. 

2-DG has earlier been explored as an anti-cancer therapy. “The ability of 2-deoxy-d-glucose (2-DG) to interfere with d-glucose metabolism demonstrates that nutrient and energy deprivation is an efficient tool to suppress cancer cell growth and survival. Acting as a d-glucose mimic, 2-DG inhibits glycolysis due to formation and intracellular accumulation of 2-deoxy-d-glucose-6-phosphate (2-DG6P), inhibiting the function of hexokinase and glucose-6-phosphate isomerase, and inducing cell death” (Int J Mol Sci. 2019 Dec 29;21(1):234).

The ongoing second pandemic wave has created a huge demand for oxygen; hence, this drug has come at an opportune time. By reducing oxygen demand, it will reduce hospitalization. The cost of this drug is not yet determined, but we hope that it would be affordable, so that it is accessible to the large majority of people and thus help save precious lives.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA