"We, from [professional organizations], have been discussing [for the] past three days about dexamethasone because the results in England were quite convincing," said pulmonologist Agus Dwi Susanto, the chairman of the Indonesian Society of Respirology (PDPI) who helped draft the country's coronavirus treatment protocol.

Indonesian doctors have been relying on a protocol issued by the PDPI, Indonesian Cardiologist Association (PERKI), Indonesian Internist Association (PAPDI), Indonesian Anesthesiology and Intensive Therapy Association (PERDATIN) and Indonesian Pediatrician Association (IDAI).

The protocol includes another kind of steroid, hydrocortisone, for severe and critical cases, Agus said, adding however that there had been no further study of its efficacy.

Results of trials conducted and announced recently by Oxford University, known as RECOVERY trial, showed that dexamethasone reduced the death rate by around a third among the most severely ill COVID-19 patients admitted to hospitals, Reuters reported.

Martin Landray, an Oxford University professor coleading the trial, said the results showed that if COVID-19 patients on ventilators or oxygen were given dexamethasone, it would "save lives" at a "remarkably low cost".

The anti-inflammatory drug is commonly used to treat diseases like arthritis, allergic reactions, immune system disorders and respiratory disorders among others.

Read also: Public urged not to buy dexamethasone for COVID-19 treatment

Agus said the medical associations were still in discussion of whether or not to include dexamethasone in an updated protocol that was currently in the works as experts began to take into account emerging studies on other drugs by other countries.

If the associations deemed the study scientifically valid with desired results, they would add the drug to the new protocol, which Agus expected would be launched next week.

"Because we are indeed in need of medicines that can speed up recovery in severe cases. With the recent study, dexamethasone has become one of the options," he said.

Indonesia has recorded the highest number of fatalities in Southeast Asia at 2,339 deaths from 42,762 confirmed cases and 16,798 recoveries as of Thursday.

Indonesian Pharmaceutical Association (GP Farmasi) executive director Dorodjatun Sanusi said dexamethasone had long been commonly used in the country, where some 10 companies have permits to market the drug.

He could not give an estimate of the drug's current stock as it would depend on the availability of imported materials, which could be difficult to purchase now as prices had spiked amid disruptions in global supply chains. If Indonesia were to use the drug, he said, there should be a projection on how much would be needed to allow industries to prepare themselves.

Read also: Indonesia records new daily highs in cases during transition to 'new normal'

Maksum Radji, a clinical microbiologist at the University of Indonesia's (UI) School of Pharmacy said that while experts had pinned their hopes on dexamethasone, clinicians must remain cautious as the announced results were only preliminary, especially as they had not been fully peer-reviewed and published in an international scientific journal.

"Some doctors have expressed concerns that using dexamethasone can worsen patients' immune system against the virus [...] Dexamethasone is not an antiviral drug, so when it's used later, there need to be further studies on how to combine dexamethasone with antiviral drugs that can inhibit the COVID-19 virus," he said.

As dexamethasone is easily accessible and affordable, Maksum warned against self-medicating of the drug, which he said was categorized as an immunosuppressant, meaning it inhibited the immune system.

Some of the side effects are fever, nausea, headache and insomnia, he said, adding that there must be extra caution when prescribing the drug to those with a history of tuberculosis, diabetes, hypertension, heart diseases, kidney diseases and blood clotting disorders.

The World Health Organization said it was looking forward to the full data analysis of the study and would update its clinical guidance to reflect how and when the drug should be used in COVID-19 treatment, Reuters reported.

Read also: WHO moves to update COVID-19 guidance after ‘great news’ in drug study

It also announced on Wednesday that it would halt testing on the malaria drug hydroxychloroquine in its large multicountry trial of treatments for COVID-19 patients, which involves Indonesia, after new data and studies showed no benefits.

Health Ministry official Irmansyah, who is part of Indonesia's Solidarity Trial steering committee, said the country would stop recruiting new patients for the hydroxychloroquine trial.

He added that so far, 25 Indonesian hospitals were participating in the trial, 22 of which have recruited some 420 patients; 70 for testing hydroxychloroquine. He said no serious safety problems were found in patients taking it.

President Joko "Jokowi" Widodo said in late March that the government would provide millions of hydroxychloroquine pills, not long after United States President Trump called the drug a potential "game-changer".

Agus of the PDPI said clinicians could still use hydroxychloroquine for COVID-19 patients in Indonesia, as recent studies had found no meaningful clinical and statistical links between the use of the drug and an increase in deaths or other side effects, such as fatal arrhythmia. He said, however, the medical associations would look further into the matter to decide on whether the drug would still be added to the new protocol.

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