- WHO recommendation based on own analysis of 7 trials, including 3 new trials
- The studies show deaths can be reduced by 20%
- Zydus Cadila and Wockhardt are main Indian makers of dexamethasone
- Hydrocortisone another drug to have proven successful in recent studies
The World Health Organisation (WHO) has recommended doctors to use anti-inflammatory drug corticosteroids like dexamethasone and hydrocortisone in the treatment of COVID-19, following an analysis of various trials that proved to reduce deaths in critically ill patients by 20 per cent - a drop from two deaths per five patients to one in three. It has also warned the doctors not to use these drugs in non-severe COVID-19 patients.
"Work on this guidance began on 22 June when the recovery trial published a preliminary report on the impact of corticosteroids. To supplement the results, WHO partnered with investigators of seven trials on corticosteroids to conduct a meta-analysis of these trials, in order to rapidly provide additional evidence," said WHO.
The recommendation is based on three new studies, plus four other earlier trials, all involving a drug from the family of corticosteroids. The three new trial results were published this week in the Journal of the American Medical Association - one with dexamethasone in 299 patients in Brazil, another in France using hydrocortisone in low doses in 76 patients and a 379-patient study with hydrocortisone in the United States and seven other countries.
At present Gilead's Remsedivir is the only widely accepted medication to treat severe COVID-19 patients. Another cheap drug Hydroxychloroquine (HCQ), which was seen as a potential COVID treatment, was later proved to have no benefit in hospitalised patients. Various countries removed it from the treatment protocol, including India. Dexamethasone, a cheap and six-decade old molecule mainly manufactured by numerous Indian generic companies, is used to reduce inflammation and treat auto-immune disorders like rheumatoid arthritis and some forms of cancer. Zydus Cadila and Wockhardt are the main manufacturers of this drug with a current domestic market of over Rs 100 crore and an export market worth $15.34 million in the year 2019-2020 (April-January).
The global tropical corticosteroids market is expected to reach $4,440.38 million by 2024, from $2,828.36 million in 2016, growing at a CAGR of 5.8 per cent, says a Research and Markets study.
There are several types of corticosteroids, including cortisone, prednisone, dexamethasone, prednisolone, betamethasone and hydrocortisone. Cortisone was the first corticosteroid drug approved for use in the US, which happened in 1950 Fludroxycortide mainly used in skin irritations, rheumatoid arthritis and lupus drug betamethasone and hydrocortisone to treat redness, swelling, itching, and discomfort of various skin conditions etc are some of the popular cortico-steroid drugs.
A large trial conducted by Oxford University in June in the UK had shown dexamethasone could reduce deaths by up to one third in hospitalised patients with severe respiratory complications of COVID-19. The US National Institutes of Health also had recommended use of dexamethasone to treat hospitalised patients who require ventilators or oxygen. Although doctors in many countries started using dexamethasone following the news, the WHO said it was a preliminary data and more understanding was needed on how dexamethasone works on COVID-19 patients.