Covid treatment: Dexamethasone findings may throw light on use of other steroids, asthma drugs

Preliminary findings from the UK on the corticosteroid dexamethasone, and its ability to prevent death in a section of patients with severe Covid-19 infection, has not caught doctors entirely by surprise.

In fact, they say, it shines a light on other steroids used in similar hospital situations, besides inhaled asthma drugs.

“Over the last several weeks, hospitals have been using steroids like methylprednisolone in combination with other drugs in moderation for severe Covid-19 patients,” said Suranjit Chatterjee, a senior internal medicine consultant with Delhi’s Indraprastha Apollo Hospital. A significant insight from the UK study is the reduced dose and duration of use of dexamethasone, he added.

The Oxford University trial had revealed that dexamethasone reduced mortality by about one-third for patients on ventilators, and one-fifth for patients requiring oxygen. Lauding the findings, the World Health Organization said it would “coordinate a meta-analysis” to increase the overall understanding of this intervention.

Generic drug

The global cheer on dexamethasone is also because of the fact that it is a generic drug, and so is less expensive (about £5) as compared to the price of a new drug or vaccine. In India, the drug is also under price control and, according to industry insiders, companies including Zydus Cadila, Cadila Healthcare and Wockhardt are already make the drug, laying the foundation for global supplies from India if required. It is priced at a little over ₹2 for a strip of 10 tablets, an industry expert said.

Chatterjee tempers the enthusiasm around the drug with caution. The steroid is used to treat allergies, rheumatoid diseases, gastro-enteric conditions and infection. When used in infectious cases, it can be a “double-edged” sword if not prescribed carefully. “It should not be given at an initial stage. It is a matter of judgment and the drug is given only when the inflammation markers and the need for oxygen in the patient are high,” he explained.

Asthma drugs, too?

Chest physician Sujeet Rajan believes the findings shine a light not just on other steroids used in these conditions, but also on inhaled steroids used in asthma drugs and their potential to prevent Covid. “I have seen less, in fact just one, asthma patient with Covid,” said Rajan, a consultant respiratory physician with Bombay Hospital. Asthma patients usually account for up to 30 per cent of those visiting a chest physician. “There are five ongoing trials on ciclesonide,” he said, substantiating his observation.

The UK trial findings will fine-tune the duration and dose of the steroids being administered to Covid patients, he said, given that many hospitals use these drugs for longer periods, resulting in secondary problems. And while chest physicians usually do not opt for dexamethasone because of fluid retention, he said, the lower dose and duration of use may not pose a problem.

Pointing to the Indian companies making these drugs, Sudarshan Jain with the Indian Pharmaceutical Alliance said: “India is at the centre-stage of many of these developments and can supply at an economical rate and build scale, if required.” Replying to whether sourcing of the active pharmaceutical ingredients could pose problems (if they are sourced from China) he said companies were looking to keep the API in-house as much as possible. A case in point, he added, was Zydus and hydroxychloroquine.

The India factor also came up in a tweet from Andrew Hill, who looks at medicine pricing. “Dexamethasone costs only US 25 cents for a 10-day treatment course for COVID-19, when sold in India. That’s 20p! This should be affordable for anyone with moderate to severe COVID-19 infection in any country,” he said on , Twitter.

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