BENGALURU: Clinical trials by an Oxford University team using dexamethasone to treat seriously ill coronavirus patients have been heralded as a breakthrough in the fight against Covid-19, and the Critical Care Support Team (CCST) in the state is likely to consider the medicine for treatment.
The drug is said to have reduced deaths by one-third in ventilated patients and one-fifth in patients receiving oxygen.
Dr Anoop Amarnath, Chief of Clinical Services, Manipal Hospitals, and a CCST member, said, “The trials were done on 2,104 patients, among which 33% who were on ventilators showed reduction in mortality, while 20% depending on oxygen came out alive.
But it has no benefits for patients not on respiratory support. We had a meeting in the CCST group and looked at UK trials. We are going to take a decision on introducing this as part of the state CCST programme.” He said, “There are two types of steroids, glucocorticoid and mineralocorticoid. Dexamethasone and methylprednisolone come under glucocorticoid, which reduces inflammation. We already have methylprednisolone in the Indian National Covid guidelines. We are going to take a decision on where to use glucocorticoid and on which patients. The drugs are readily usable and are cheap. In India, we use them in pneumonia cases.”
Why this drug for COVID-19
When there is a viral load in the blood, the body mounts an immunological response and releases cytokines. But a large amount of cytokines can damage heart, kidneys and lungs. “The only counteracting substance is steroids and dexamethasone is one such drug that prevents the unwelcome effect of cytokine on organs.
The body produces corticosteroids when it is under stress, but it is not enough and this drug supplements it. The drug is not anti-viral and does not act against the coronavirus itself but helps reduce mortality due to organ damage caused by cytokines,” said Dr Murali Chakravarthy, MD and Chairman, Central Infection Prevention and Control Committee, Fortis Hospital.
He said this drug has low potency and is used in treating allergies, asthma, sepsis, immunosuppression needed after organ transplants, etc. “The beauty of the UK study is that only 6 mg was used to mitigate the cytokine response,” he added.
Possible cons of the drug
What has not been discussed in the UK study is the side-effects of dexamethasone and this will be known when more research is conducted. “It suppresses the immunity and prevents organ dysfunction caused by Covid. But lesser immunity means the patient is more susceptible to bacterial infections. One may not die of Covid, but a bacterial infection.
That’s why this drug is recommended only for severe cases. Side-effects include ulcers in the stomach and intestine. The UK study recommends a small dose and therefore lesser side-effects,” Dr Murali said.
Dr Giridhara R Babu, Professor, Head, Lifecourse Epidemiology, Indian Institute of Public Health, Bengaluru, said, “This is the most overused drug in the country. It reduces inflammation but can cause renal damage. It is not good in the long run. It is now an over-the-counter drug in the country, but it should not be made available without a prescription.”
1. WHAT IS DEXAMETHASONE?
It is a steroid which mimics anti-inflammatory hormones to reduce inflammation caused when the immune system begins attacking the body’s own cells instead of the virus.
2. WHAT DOES IT DO?
In serious or critical cases, the immune system, which is supposed to fight the SARS-CoV-2 virus, can turn on the ‘good cells’ in the body. This has caused many a death. Dexamethasone, by mimicking anti-inflammatory hormones, slows down or even halts the immune system’s destruction of the body’s own cells.
3. HELPS ONLY THE CRITICAL PATIENTS
Because of this, it is understood to be of use only in serious or critical cases wherein the immune system has gone berserk. It is found not to be working on patients with mild symptoms or asymptomatic patients.
4. PREVENTS DEATHS
Dexamethasone trials on Covid-19 patients conducted by the University of Oxford revealed it prevents deaths in one in three serious/critical patients, and one in five among patients on oxygen.
The drug treatment is affordable and it is also easily available. In Britain, currently, the treatment cost is equivalent of Rs 516 (or £5.40) per day.