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Wednesday, September 30, 2020

Improved survival rate in COVID patients brings boost in demand for India’s Rs 105-cr dexamethasone market

Dexamethasone sales across the country increased around 10 per cent between May and June, according to pharmaceutical market research firm AIOCD Awacs PharmaTrac.

Written by Prabha Raghavan | Updated: July 20, 2020 11:06:21 am
Dexamethasone, which internationally showed the ability to improve survival in severe or critical patients nearly a month ago, has shown the highest growth in domestic sales between May and June. (File)

The use of steroids in COVID-19 treatment has seen a rise in hospitals over the last few months on the back of improved confidence in their effectiveness as part of treatment protocol. Of them, dexamethasone, which internationally showed the ability to improve survival in severe or critical patients nearly a month ago, has shown the highest growth in domestic sales between May and June.

On June 16, researchers leading the Oxford University’s RECOVERY clinical trial had termed dexamethasone the “first drug to be shown to improve survival” because it had reduced deaths of up to a third of patients on ventilator support. The findings had brought India’s Rs 105-crore dexamethasone market under the spotlight — an anti-inflammatory steroid under price control, it is priced at below Rs 0.25 for a 0.5 mg tablet.

Since then, domestic demand for the low-cost drug has seen a spurt, according to chemists and manufacturers. “There has been a significant increase in the demand of dexamethasone. The demand has increased by more than 50 per cent,” said a spokesperson from Cadila Pharmaceuticals, known to be the third largest manufacturer of the drug.

Dexamethasone sales across the country increased around 10 per cent between May and June, according to pharmaceutical market research firm AIOCD Awacs PharmaTrac. Compared with other crucial steroids like prednisolone (around 12 per cent) and methylprednisolone (around 17 per cent), it saw the highest growth — around 22 per cent — among high burden states like Maharashtra, Tamil Nadu, Karnataka and Delhi during this period.

Data for sales of the drug so far in July are not available yet, but doctors treating COVID-19 patients attest to a rise in its use following the results of the Oxford study. In some parts of India, it has found its way into the treatment regime of even moderate cases.

Max Healthcare, which has treated around 5,000 patients since April, now uses either dexamethasone or methylprednisolone in “at least” 50-70 per cent of the COVID-19 patients it treats for moderate conditions across its hospitals. Earlier, steroids in general were given to 30 per cent of the patients treated at Max at most, according to the group’s medical director, Dr Sandeep Budhiraja. “The usage is equally divided between dexamethasone and methylprednisolone,” he said. “The benefit of steroids is their effects start within 8-12 hours. It really helps control hyper inflammation,” Budhiraja added.

The study has also added to confidence among doctors in Delhi to use steroids overall as part of COVID-19 treatment. PharmaTrac data shows sales of dexamethasone, prednisolone and methylprednisolone surged around 43 per cent between May and June in Delhi. “Steroids were always a big controversy right from the start of the pandemic. Conventionally, they would hardly even be used in viral pneumonia cases that were being treated before the outbreak. This situation is different and there has been serious change in several concepts, including the use of steroids,” said Budhiraja.

In other regions where steroids were already a part of COVID-19 care, dexamethasone has become an integral part of treatment in severe to critical patients. Going by the new evidence, Fortis Hospital-Mulund’s director of intensive care, Dr Rahul Pandit, has switched a “majority” of his ventilated patients over to dexamethasone from other steroids like methylprednisolone.

“After the Oxford trial, we are using dexamethasone more than methylprednisolone … most people would have shifted to dexamethasone (at least) for patients who are on ventilator,” he said. This would be at least 3-5 per cent of the total COVID-19 patients he has been treating.

Yet, unlike the enthusiasm witnessed for drugs like hydroxychloroquine (HCQ) in the earlier stages of the pandemic, international demand for dexamethasone seems muted. The Pharmaceutical Export Promotion Council of India (PHARMEXCIL) has received “very few” enquiries about dexamethasone from the UK and EU, according to the body’s chairman, Dinesh Dua.

Global demand for HCQ in April had been around 10 times more, he said. For one, dexamethasone is a steroid globally known for results in patients on ventilator support — a miniscule proportion of the total COVID-19 cases.

Even in hospitals in India, dexamethasone’s use varies. Doctors say it is used as much as, if not less than, steroids like prednisolone and methylprednisolone in moderate to critical cases. Surely enough, at around three million units compared to around 1.6 million units, prednisolone was sold more than dexamethasone across Delhi, Maharashtra, Karnataka and Tamil Nadu in June.

“The Oxford study also came out around the time that remdesivir (another commonly used COVID-19 medication) became available here. There is an interaction between remdesivir and dexamethasone that makes steroids like methylprednisolone better to use instead,” said Dr Shashank Joshi, Dean of the Indian College of Physicians.

Prednisolone and methylprednisolone also have a wider spectrum of action than dexamethasone, according to Dr Om Srivastava, who treats COVID-19 patients at different hospitals in Mumbai. But, for him, the results of the Oxford study show that dexamethasone “definitely” has a role to play in the treatment of patients of moderate disease. “In patients who are not critically ill, I start with dexamethasone. In patients who become critically ill, I switch back to any preparation of … prednisolone,” he said.

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