E-Paper
Cheap steroid first life-saving drug in Covid fight, says study
The cheap and widely available steroid drug dexamethasone can save one in three critically ill coronavirus disease (Covid-19) patients , according to the much awaited results of a scientific scrutiny by the University of Oxford published in a pre-print journal on Monday.
The cheap and widely available steroid drug dexamethasone can save one in three critically ill coronavirus disease (Covid-19) patients , according to the much awaited results of a scientific scrutiny by the University of Oxford published in a pre-print journal on Monday.
Dexamethasone, a low-dose steroid that is manufactured in India and costs a few rupees, has been used for 60 years to treat inflammatory diseases and sceptic shock.
India has approved the use glucocorticoid, which is another steroid with similar action, to treat critically ill Covid-19 patients in intensive care units (ICUs) who need ventilatory support.
Results from the UK’s RECOVERY (Randomised Evaluation of COVid-19 thERapY) trial show the steroid reduced death by a third in hospitalised Covid-19 patients who needed invasive ventilator support to help them breathe, and by a fifth in those who needed oxygenation but not ventilation, when given as a 6mg dose per day for up to 10 days.
Dexamethadose is the first treatment to prevent death from Covid-19. “Although (the antiviral) remdesivir has been shown to shorten the time to recovery in hospitalised patients, no therapeutic agents have been shown to reduce mortality,” said the report, published in medRxiv, a preprint server that publishes scientific studies before peer review to inform potentially lifesaving decisions.
Both remdesivir and dexamethasone are manufactured in India.
“The data is conclusive for moderately and severely sick ICU patients, especially for those very sick on ventilators. The drug will also be useful for those with difficulty breathing that needs oxygen constantly, despite proning,” said Dr K Srinath Reddy, president, Public Health Foundation of India, and an independent expert on the World Health Organisation’s Global Executive Group of the Steering Committee on Solidarity trial.
Proning refers to patients with acute respiratory distress syndrome who are asked to lie flat on their stomach with the chest down and the back up (prone position) during mechanical ventilation to improve oxygenation and reduce mortality.
Scientists say Covid-19 is associated with diffuse lung damage, which makes corticosteroid an effective drug to help modulate immune-mediated lung injury and reduce its progression to respiratory failure and death.
“I would generalise and say that as of now, our most effective strategy is in reducing the inflammatory response in the later stages of Covid-19. Steroids like dexamethasone seem to be partially effective. Other steroids (glucocorticoids) are already being used in India during this phase of the disease. Now there is evidence for effectiveness, which is important. I do not expect a difference between dexamethasone or other glucocorticoids at equivalent doses,” said Dr Anurag Agrawal, director, Council of Scientific and Industrial Research-Institute of Genomics and Integrative Biology, New Delhi.
The Oxford group announced preliminary findings on June 16 in a press release, instead of a medical journal, which were welcomed by WHO but criticised by some as “science by press release” because the findings were announced without the trial data being shared for scientific scrutiny. RECOVERY halted the dexamethasone arm of the trial on June 8 after the drug showed significant benefits in a sufficient number of patients.
The RECOVERY trial, which enrolled 11,500 patients from at least 175 hospitals in the UK in March to test a range of potential treatments for Covid-19, last month suspended the hydroxychloroquine arm of the trial after it found the anti-malaria drug did not benefit patients.
Dexamethasone, however, was not found to benefit hospitalised Covid-19 patients not receiving respiratory support, with “results consistent with possible harm in this group,” according to the RECOVERY trial data.
“The important caution is that it would worsen the disease if used too early,” said Dr Agarwal.
WHO on Monday called for a rapid increase in the production of the steroid. “Although the data is still preliminary, the recent findings that the steroid dexamethasone has life-saving potential for critically ill Covid-19 patients gave us a much-needed reason to celebrate,” WHO director-general Dr Adhanom Ghebreyesus Tedros said at the health agency’s daily virtual briefing on Monday.
“The next challenge is to increase production and rapidly and equitably distribute dexamethasone worldwide, focusing on where it is needed most. Demand has already surged, following the UK trial results showing dexamethasone’s clear benefit,” he added.
WHO also cautioned that dexamethasone must only be used for patients with severe or critical disease, under close clinical supervision. “There is no evidence that the drug works for patients with mild disease or as a preventative measure, and it could cause harm,” said Dr Tedros.
