The Centre Saturday issued revised clinical management protocols for treatment of Covid-19 patients, including the low-cost anti-inflammatory drug Dexamethasone as an alternative to another steroid, Methylprednisolone, for moderate to severe cases.
The move by the Union Ministry of Health and Family Welfare comes after Oxford researchers leading the RECOVERY clinical trials in the United Kingdom had announced that Dexamethasone reduced death by up to one-third in hospitalised Covid-19 patients who develop acute respiratory complications.
Both Dexamethasone and Methylprednisone are corticosteroids, which closely mimic cortisol, a hormone naturally produced in humans by adrenal glands. Dexamethasone is commonly used for treatment of rheumatological inflammatory conditions: inflammation of muscles, inflammation of blood vessels, chronic arthritis, and lupus.
Even before Oxford University had announced the results of the Dexamethasone arm of the trial on June 16, India had already allowed the use of Methylprednisolone, as corticosteroid therapy in moderate and severe cases.
In the management of severe cases, the revised guidelines state: “For 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).”
The guidelines add a note of caution: “A larger dose of glucocorticoid will delay the removal of coronavirus due to immunosuppressive effects.”
In the Oxford Dexamethasone trial, 2,104 patients were administered the drug for 10 days, and the researchers said they saw fatalities fall by one-third in ventilated patients and by one-fifth in patients on oxygen.
“Based on these results, 1 (one) death would be prevented by treatment of around 8 ventilated patients, or around 25 patients requiring oxygen alone,” the university said.
However, the study had found no evidence of benefit for patients who did not require oxygen. The trial did not study patients outside hospital settings either.
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