Dexamethasone may have emerged as the wonder drug helping critical Covid patients get better but the civic body is yet to introduce it in its treatment protocol. The Brihanmumbai Municipal Corporation has been using another steroid--methylprednisolone--in use since April 2019 and claims this has helped to improve the condition of patients within 72 hours. However, doctors caution that the overuse of steroids can have serious side effects.
In use since the 1960s, dexamethasone reduces inflammation in a range of conditions and has been on the WHO's list of essential medicines since 1977. It is cheap and easily available.
Senior doctors from BYL Nair Hospital said they have been successfully using another medication, methylprednisolone, to treat patients with moderate to severe coronavirus. It reduces mortality and the severity of symptoms, doctors claimed. “Nearly 1,000 are patients are being administered methylprednisolone daily and they have shown improvement,” he said.
“Steroids are effective in dealing with Covid-19 and they reduce complications and their severity in sick patients. Dexamethasone would be a good choice, as it is supported by a large trial and is a cost-effective drug," doctor added.
On Wednesday, the World Health Organisation (WHO) had said that initial clinical trial results from Oxford University showed dexamethasone to be lifesaving for critically ill Covid-19 patients. “For patients on ventilators, the treatment was shown to reduce deaths by a third, and for patients requiring only oxygen, mortality was cut by about a fifth, according to preliminary findings shared with WHO,” said doctor.
Doctors from the medicine department of Nair hospital said currently there were no plans for dexamethasone trials but at their next meeting they planned to seek permission to add it to the treatment protocol. “Both drugs are effective in the patient treatment, but a UK study has proved that dexamethasone is more effective. We will also put forth the suggestion to use dexamethasone for critical patients.”
Dexamethasone and methylprednisolone are both corticosteroids, hence the effects will be similar. Although diabetics have a disarrangement of blood sugar values with steroids, these are deemed necessary to use in Covid infection, as they are life-saving drugs, according to health experts.
“There are two types of steroids, glucocorticoid and mineralocorticoid. Dexamethasone and methylprednisolone come under glucocorticoids, which reduce inflammation. We already have methylprednisolone in the Indian National Covid guidelines. We are going to take a decision on where to use glucocorticoids and on which patients. The drugs are readily usable and are cheap. In India, we use them in cases of pneumonia,” said health experts.
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 the 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 a doctor.
