Why in News

Recently, scientists administering the World Health Organisation’s RECOVERY trial have reported that dexamethasone reduced Covid-19 deaths in severe patients.

• Dexamethasone is a cheap and widely available steroid drug.

Key Points

• Highlights of the Research:

  • The drug was given either orally or through an IV (intravenous).
  • After 28 days, it had reduced deaths by 35% in patients who needed treatment with breathing machines and by 20% in those only needing supplemental oxygen.
  • The drug is not helpful for less ill patients and for those who do not need respiratory support.
  • According to the estimates, this drug can prevent one death for every eight patients treated while on breathing machines and one for every 25 patients on extra oxygen alone.

• Drug Mechanism:

  • Multi-system Inflammatory State is a Covid-19 related illness that causes inflammation of the blood vessels leading to low blood pressure, affecting the entire body as it causes a build-up of fluid in the lungs and other organs.
  • The inflammation can be fatal so steroids and other anti-inflammatory drugs are used to reduce it.
  • Dexamethasone is not an anti-viral but works to modulate the immune response of the body when confronted by a viral infection such as Covid-19.

• Benefits:

  • The survival benefit is clear and large in severe patients.
  • It is highly affordable, easy to make, can be scaled up quickly and only needs a small dosage.
  • It is a cheaper option than tocilizumab, an injectable, which is also being tested.

• Concerns:

  • The WHO advises that steroids should not be used early in a course of illness because they can slow the time until patients clear the virus.
  • Excessive use of steroids can lead to adverse reactions like major mood swings, aggression and irritability, delusions, kidney/liver damage, increased blood pressure, etc.

• India’s Reaction:

  • Indian doctors have welcomed the research as good news for Covid-19 patients on ventilators.
    
    • The drug is affordable and easily available in India.
  • Earlier, the Indian Council for Medical Research (ICMR) revised the protocol for clinical management of Covid-19 and allowed the use of remdesivir, tocilizumab and Convalescent Plasma Therapy (CPT) on certain groups of patients.
    
    • Remdesivir reduced hospital stays for very sick Covid-19 patients but has not been shown to improve recovery itself.

• Other Findings from the Research:

  • Earlier, the same study showed that the malaria drug hydroxychloroquine was not working against the coronavirus.
  • The study enrolled more than 11,000 patients in England, Scotland, Wales and Northern Ireland who were given either standard of care or that plus one of the treatments mentioned below:
    
    • Dexamethasone.
    • HIV combo drug lopinavir-ritonavir.
    • Antibiotic azithromycin.
    • Anti-inflammatory drug tocilizumab.
    • Plasma from people who have recovered from Covid-19 that contains antibodies to fight the virus.