NEW DELHI: The government on Saturday revised the clinical management protocol for treating Covid-19 patients to allow use of commonly used steroid dexamethasone, the first drug to show improved survival in severe patients of SARS Cov2 virus in recent trials by Oxford University.
Research findings show dexamethasone lowers fatality in those needing oxygen by 20% and by 35% in those on a ventilator.
Dexamethasone is part of the National List of Essential Medicine and is under government price control, which makes it highly affordable. A strip of 20-tablets of 0.5 mg each is priced at Rs 6.38.
The drug is also easily available in India as local firms have been manufacturing it for decades.
Use of dexamethasone has been allowed as an alternative to methylprednisolone. Both these drugs are steroids with anti- inflammatory and immune-suppressants.
“In 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). It is recommended that the 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,” the new guidelines say.
Keeping pace with the evolving knowledge about Covid-19, especially in terms of effective drugs, the change has been made after considering the latest available evidence and expert consultation, the health ministry said.
The move assumes significance as the inclusion of the drug under treatment protocol in India will help save many patients at the critical stage and lower deaths due to Covid-19.
Union Health Secretary Preeti Sudan has also forwarded the updated protocol to all states and Union Territories to make necessary arrangements for availability and use of the new protocols and the dexamethasone at the institutional level also, it said.
The health ministry had on June 13 also allowed the use of antiviral drug remdesivir for restricted emergency use and off-label application of tocilizumab, a drug that modifies the immune system or its functioning, and convalescent plasma for treating Covid-19 patients in the moderate stage of the illness as an 'investigational therapy'.
It also recommended hydroxychloroquine in patients during the early course of the disease and not on critically ill patients. The use of these drugs continues to be included in the 'Clinical Management Protocols for Covid-19' under 'investigational therapy'.
The revised treatment protocols for moderate cases advised considering methylprednisolone 0.5 to 1 mg/kg or dexamethasone 0.1 to 0.2 mg/kg for three days, preferably within 48 hours of admission or if oxygen requirement is increasing and if inflammatory markers are increased.
The duration of administration should be reviewed as per clinical response, it said.
The drug has been tested in hospitalised patients with Covid-19 in UK’s recovery clinical trial and was found to have benefits for critically ill patients.