WHO chief scientist hails Dexamethasone success in trials says will impact treatment guidelines

It is available for just around Rs 3 a tablet and could well be the drug to treat critically-ill patients of coronavirus. The internet and social media are awash with news clips and reports from the UK of the biggest trial conducted so far on the Dexamethasone and coming out with evidence that this steroid given in low doses can help cut the risk of death in critically-ill patients. It is a cheap and widely available steroid that is used as an anti-inflammatory medicine globally and in India.

BusinessToday.In reached out to Dr Soumya Swaminathan, Chief Scientist at the World Health Organisation (WHO), on what changes now and if we now finally have a treatment for COVID-19?  "It is a well-done randomised trial with large number of patients. This is the kind of evidence we need for any drug. Second, the results show that it works best in the most severely ill patients that is those who already have a respiratory failure and need oxygen or mechanical ventilation."

It is a good result and a positive result but there is a caveat that it is only for patients who are critically ill and on support, she further says. "There are many other trials that are going on but this is the largest of them all on Dexamethasone and the WHO will be looking at all the trails that are going on and do a meta analysis and put together all the results. It will have an impact on the treatment guidelines," Swaminathan says. "It is not yet published and is only a press release. The full data has to come out and we know that there are at least 10 other trials that are going on and we need to put together all the results from the different trials and we are in the process of doing that."

Only for critically-ill COVID-19 patients

Swaminathan cautions that Dexamethasone should not be used on people who are not yet critically ill. It is very clear that it does not have any impact on people who do not have that kind of lung damage. The risk is that taking Dexamethasone, which is a corticosteroid, inappropriately could worsen the situation in an infection, she warns.

"It is therefore important that it should be prescribed by a doctor and it should be done only in a hospital setting and in patients who fulfill the criteria which were used in the trial," says the WHO Chief Scientist.

Swaminathan is also pleasantly surprised by the findings because she says, Dexamethasone, which is not yet part of the Solidarity trials "has been used for such a long time and there has never been any conclusive evidence. So, in a way, this is the first time that it has been shown very conclusively to have a benefit, so it is good."

But then, talk to doctors in India and some were not surprised at all. In fact, some doctors told BusinessToday.In that this drug was being used on critically ill patients. "It is a very commonly used drug, inexpensive too, and is probably being used by the doctors in different part of the world on critically ill patients. What makes a difference now is that you have the evidence that it has the effect," says Swaminathan.

In the backdrop of this, where the other drugs figure? Remdesivir for instance? "Remdesivir has not yet shown this type of result. It has only shown that it reduces hospitalisation by about 30 per cent and has not show mortality benefit in any trial so far," Swaminathan says.

So, what next now. "We have to look at the full data that is presented along with data from all the other trials that are going on and it is clear that this will impact the treatment guidelines for a subgroup of patients - those who are critically ill and on oxygen or ventilator support, which is a minority of patients - but if it can save lives then naturally it is very welcome and should be used in the group of most severely ill patients. The treatment guidelines are constantly updated based on new evidence such as this," Swaminathan says.