NEW DELHI: Nearly 10 days after a large study published by researchers at Oxford University said that the steroid dexamethasone has been found to lower mortalities in very sick Covid-19 patients, India has included the drug in its clinical management protocol for the disease.
In the revised guidelines issued on Saturday, the Union Ministry of Health and Family Welfare said that dexamethasone can be given to severe Covid-19 patients as an alternative to another steroid methylprednisolone — which was included in the protocol long back.
Dexamethasone is a type of corticosteroid that has long been used for its anti-inflammatory and immunosuppressant properties.
“For 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),” said the advisory.
“It is recommended that 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,” it added.
The Recovery Trials in the UK, the largest randomised clinical trials to assess the efficacy of various therapeutic interventions on Covid-19 patients, had shown that dexamethasone, helps patients experiencing acute inflammatory response called a cytokine storm.
As part of the trial, a total of 2,104 patients were randomised to receive dexamethasone 6 mg once per day for ten days and were compared with 4,321 patients randomised to usual care alone.
The results showed that mortality rate in patients who required ventilation and were given dexamethasone fell from 41 percent to 28 percent whereas, in moderately sick patients who required oxygen support only, the deaths were reduced by a fifth.
Doctors in India say that dexamethasone which is given orally, as intramuscular injections or intravenously is commonly used for conditions such as rheumatic issues, skin diseases, extreme allergies, respiratory diseases, swelling in the brain and eye pain following eye surgeries apart from cancer.
The medicine has been in use for nearly four decades, is cheap and widely available.
Meanwhile, a small observational study on another steroid- methylprednisolone, part of the protocol, from a Mumbai hospital has also shown that it may be cutting down deaths in very sick Covid-19 patients.