Health Ministry adds steroid dexamethasone in COVID-19 treatment protocol

Dexamethasone, an inexpensive and widely used steroid, was included in the treatment protocol for COVID-19 patients in moderate to severe stages of illness by the Union health ministry on Saturday.

The updated 'Clinical Management Protocols for COVID-19' advises the use of dexamethasone, which is already used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects, as an alternative choice to methylprednisolone for managing moderate to severe cases of COVID-19.

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.

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 updated 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.

For patients having respiratory distress requiring mechanical ventilation, both non-invasive and invasive, the ministry said methylprednisolone 1– 2mg/kg/day or dexamethasone 0.2 to 0.4 mg/kg per day should be considered for five to seven days in two divided doses, if not given already.

"Note that a larger dose of glucocorticoid will delay the removal of coronavirus due to immunosuppressive effects," the treatment protocols stated.

The revised treatment protocols were issued as India's COVID-19 tally raced past the five-lakh mark on Saturday with the biggest single-day surge of 18,552 cases, while the death toll climbed to 15,685 with 384 fatalities.

Dexamethasone is a corticosteroid drug used in a wide range of conditions for its anti-inflammatory and immunosuppressant effects.

"The drug has been tested in hospitalised patients with COVID-19 in the recovery clinical trial and was found to have benefits for critically ill patients and has been shown to reduce mortality by about one third for patients on ventilators, and by about one fifth for patients being maintained on oxygen therapy," the ministry said.

The drug is also a part of the National List of Essential Medicines (NLEM) and is widely available, it said.