The Union heath ministry on Saturday revised clinical management protocols for the coronavirus disease (Covid-19), and added the steroid dexamethasone for use on patients with progressive deterioration of oxygenation indicators, rapid worsening on imaging and excessive activation of the body’s inflammatory response.
“The updated protocol includes the advice to use Dexamethasone as an alternative choice to Methylprednisolone for managing moderate to severe cases of Covid-19. The change has been made after considering the latest available evidence and expert consultation,” the ministry said in a statement.
The dosage recommended is 0.2-0.4mg/kg/day for a period of 3-5 days.
Health secretary Preeti Sudan has written to state governments to follow the updated protocol, and to make necessary arrangements for availability and use of the drug in all hospitals.
A cheap and widely available steroid drug, dexamethasone can save one in three critically ill Covid-19 patients, according to the results of a scientific scrutiny by the University of Oxford published in a preprint journal on Monday.
“Dexamethasone is a corticosteroid drug used in a wide range of conditions for its anti- inflammatory and immunosuppressant effects. The drug has been tested in hospitalized patients with COVID-19 in the RECOVERY clinical trial and was found to have benefits for critically ill patients and has been shown to reduce mortality by about one third for patients on ventilators, and by about one fifth for patients being maintained on oxygen therapy. It is manufactured in India, costs a few rupees, and has been used for 60 years to treat inflammatory diseases and sceptic shock,” a statement by the health ministry read.
Dexamethasone is the first treatment to prevent death from Covid-19. Although antiviral remdesivir has been shown to shorten the time to recovery in hospitalised patients, no therapeutic agents have been shown to reduce mortality.
“The drug has shown promise in Covid treatment in the interim results, which is why it has been taken up for use,” said Dr Anurag Agrawal, director, Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi.
The drug is also a part of the National List of Essential Medicines (NLEM).
The ministry last updated clinical management protocols for Covid-19 on June 13 to include the antiviral drug remdesivir (under emergency use authorisation) and immunosuppressant tocilizumab (off label).
Another therapy that received approval for off label use is convalescent plasma therapy in which plasma of recovered individuals is transfused to patients who are not improving.
“There is no specific medication for Covid-19 at the moment and world over these medicines are being tried in hospitalized patients currently. However, there are certain contraindications in use of these medicines so the medicine is not for everyone and needs to be started under strict medical supervision,” said Dr Yatin Mehta, chairman, critical care department, Medanta Hospital.
The World Health Organization (WHO) has also cautioned that dexamethasone must only be used on patients with severe or critical disease, under close clinical supervision, and could cause harm if given too early in the disease stage.
