On 16th June, 2020, the world heaved a sigh of relief, with the announcement from the British Press as regards the low-dose steroid treatment of ‘Dexamethasone’, confirmed by UK experts, as a major breakthrough in the fight against the deadly novel coronavirus. Dexamethasone is part of the world’s biggest trial testing existing treatments to see if they also work for coronavirus. It cut the risk of death by a third for patients on ventilators. For those on oxygen, it cut deaths by a fifth. Had the drug had been used to treat patients in the UK from the start of the pandemic, up to 5,000 lives could have been saved, as per UK researchers. The UK government has 200,000 courses of the drug in its stockpile and says the NHS will make Dexamethasone available to patients.
Dr. Michael Ryan, the Emergencies Chief, WHO, welcomed the news but said it was too soon to change how patients are treated. “It’s one of the breakthroughs we’re going to need to effectively deal with COVID-19, but it’s still preliminary data,” he said at Press briefing held on 17th June, 2020. “We will pull together the necessary expert group… and come to a decision around our clinical advice to countries,” he added.
Ryan said that this is not the time to rush to change clinical practice and that it was crucial to understand issues like what dose should be used on patients, how patients would be assessed and if there were adequate supplies of the drug. When the British researchers announced their findings, the department of health said the dexamethasone had been approved to treat all hospitalized COVID-19 patients, effectively immediately. WHO Director-General, Tedros Adhanom Ghebreyesus, noted that in the last two months, more than 6 million coronavirus cases have been logged and said cases were still accelerating globally.
These findings have brought India’s anti-inflammatory steroid Dexamethasone market under the spotlight. While medical experts here are still studying the findings to understand how beneficial it may be as part of India’s treatment protocol for COVID-19 patients, industry executives expect global demand for the drug to shoot up, like in the case of Hydroxychloroquine (HCQ), earlier.
The Indian Council of Medical Research (ICMR), on June 13, 2020, recommended the use of this drug in the clinical management of moderate cases on oxygen support. “This (the trial’s findings) is a clearly good observation in the ventilator cases,” said Dr Shashank Joshi, member of Maharashtra’s COVID-19 Task Force, in the Indian Express. While this is a welcome development, the Task Force is studying the full text of the trial before taking a call on how to incorporate it in their clinical management protocol.
Indian pharmaceutical firms have the largest share of the global volume – around 46 per cent – largely driven by the country’s own consumption of the drug. Pharmaceutical Export Promotion Council (PHARMEXCIL) Chairman, Dinesh Dua expects the demand to get “bigger” than what India experienced for Hydroxychloroquine. “Unfortunately, the API (active pharmaceutical ingredient) for Dexamethasone mostly comes from China. There are hardly one or two manufacturers in India, and they too have a very small capacity. It’s all dominated by China.” said Dua, in the Indian Express. So far, no demand for the drug has been flagged to the export promotion body, but “these are still early days”, he concluded.