Friday 03 July 2020

India revises Covid-19 management protocol, allows dexamethasone use

- Posted on 27 June 2020

New Delhi, June 27

India on Saturday revised the clinical management protocol for Covid-19 allowing the use of steroid dexamethasone, the first drug to show improved survival in severe patients of SARS Cov2 virus in recent trials by Oxford University.

The revised protocol allows dexamethasone use as an alternative to methylprednisolone. Both these drugs are steroids with anti- inflammatory and immune-suppressants.

“In patients with progressive deterioration of oxygenation indicators, rapid worsening on imaging and excessive activation of the body’s inflammatory response, glucocorticoids can be used for a short period of time (3 to 5 days). It is recommended that the dose should not exceed the equivalent of methylprednisolone 1-2mg/kg/day or dexamethasone 0.2-0.4 mg/kg/day. Note that a larger dose of glucocorticoid will delay the removal of coronavirus due to immunosuppressive effects,” the new guidelines say.

Dexamethasone drug lowers fatality in those needing oxygen by 20 per cent and by 35 per cent in those on a ventilator. What’s more – it is an on-the-shelf medicine and can be easily accessed by anyone.

UK’s RECOVERY (Randomised Evaluation of Covid-19 Therapy) trial results have generated hope in the ability of existing, repurposed drugs in mitigating Covid impact.

Shekhar Mande, Director of India’s Council for Scientific and Industrial Research, says, “The results about dexamethasone are extremely promising for the critically ill Covid-19 patients and will help reduce deaths at the severe stage of the disease. It is a huge step forward. We are very excited and are looking forward to the detailed scientific study.”

India is a bulk manufacturer of dexamethasone. A 20-tablet strip of 0.5 mg each by Zydus Cadila is available for Rs 6.38.

With easy accessibility and affordability, dexamethasone could revolutionise critical Covid care globally and lower mortality.

The RECOVERY trial began this March as a randomised clinical trial to test a range of potential treatments for Covid-19, including low-dose dexamethasone (a steroid treatment) and over 11,500 patients from 175 UK National Health Service hospitals were enrolled. 

In all, 2,104 patients were randomised to receive dexamethasone 6 mg once per day (either by mouth or by intravenous injection) for 10 days and were compared with 4,321 patients randomised to usual care alone.

Dexamethasone reduced deaths by one third in ventilated patients and by one fifth in other patients receiving oxygen only. Based on these results, one death would be prevented by treatment of around eight ventilated patients or around 25 patients requiring oxygen alone, study leader Peter Horby said.

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