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Experts eye steroid for COVID-19 treatment
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ndonesian medical experts are considering adding dexamethasone to update the national COVID-19 treatment protocol following recent global trials on potential candidate treatments for the disease.
Dexamethasone, an inexpensive and widely available steroid, was recently hailed as a “major breakthrough” in treating severe cases of COVID-19. The anti-inflammatory drug is commonly used to treat arthritis, allergic reactions, immune system disorders and respiratory disorders.
"We [on the protocol panel] have been discussing dexamethasone the past three days because the results in England were quite convincing," said pulmonologist Agus Dwi Susanto.
As the chair of the Indonesian Society of Respirology (PDPI), Agus was involved in drafting the country's COVID-19 treatment protocol along with the Indonesian Cardiovascular Specialists Association (PERKI), the Indonesian Internists Association (PAPDI), the Indonesian Association of Anesthesiologists and Intensive Therapy Specialists (PERDATIN) and the Indonesian Pediatric Society (IDAI).
Agus said that the protocol included another steroid, hydrocortisone, for treating severe and critical cases, although he noted that no further studies had been done on its efficacy in treating COVID-19.
The recently announced results of the University of Oxford’s RECOVERY clinical trials showed that dexamethasone reduced the death rate among the most severely ill COVID-19 patients by around a third, Reuters reported.
Oxford University medicine and epidemiology professor Martin Landray, who is coleading the RECOVERY trials, said that dexamethasone would "save lives" at a "remarkably low cost" when given to COVID-19 patients on ventilators or oxygen.
Agus said that the COVID-19 treatment protocol panel was still discussing whether to include dexamethasone in the latest update, which would incorporate the results emerging from clinical trials on candidate treatments in other countries.
If the panel deemed the study scientifically valid and produced the desired results, it would add the drug to the updated protocol, which Agus expected to be issued next week.
"It is because we are indeed in the need of medicines that can speed up recovery in severe cases. With the recent study, dexamethasone has emerged as one of the options," he said.
Indonesia has the highest COVID-19 death toll in Southeast Asia with 2,339 deaths, while it recorded a cumulative 42,762 confirmed cases and 16,798 recovered cases as of Thursday.
Indonesian Pharmaceutical Association (GP Farmasi) executive director Dorodjatun Sanusi said that dexamethasone had long been available in the country, where around 10 companies were licensed to market the drug.
He could not provide an estimate of the current dexamethasone stock in Indonesia, as it depended on the availability of imported raw materials that were now difficult to obtain due to spiking prices amid the disruption to the global supply chain. If Indonesia were to use the drug, he said, a projection should be made on how much would be needed to allow the industry to prepare adequate stock.
Maksum Radji, a clinical microbiologist at the University of Indonesia (UI) pharmacy school, said that while experts had pinned their hopes on dexamethasone, clinicians must remain cautious, as the announced results were preliminary and had not been peer-reviewed and published in an international scientific journal.
"Some doctors have expressed concern that using dexamethasone could [weaken] patients' immune system against the virus,” he said. “Dexamethasone is not an antiviral drug, so for later use, further studies are needed on how to combine dexamethasone with antivirals that could inhibit the COVID-19 virus."
Maksum warned against using the readily available and affordable drug in self-medication, as dexamethasone was classified as an immunosuppressant – meaning that the drug blocks the immune system’s response.
Some of the known side effects of dexamethasone were fever, nausea, headache and insomnia, he continued, and that extra caution was required when prescribing the drug to patients with a history of tuberculosis, diabetes, hypertension, heart disease, kidney disease and blood clotting disorders.
The World Health Organization said it was looking forward to the full analysis of the Oxford study and would update its clinical guidance to reflect how and when the drug should be used in COVID-19 treatment, Reuters reported.
The WHO also announced on Wednesday that it would halt testing on the antimalarial drug hydroxychloroquine in its multicountry Solidarity Trial of candidate COVID-19 treatments, after new data and studies showed that the drug presented no benefits.
Health Ministry official Irmansyah, who is on Indonesia's Solidarity Trial steering committee, said it would stop recruiting new patients for the hydroxychloroquine trial.
He added that 22 of the 25 Indonesian hospitals participating in the trial had recruited 420 patients, of whom 70 were involved in the hydroxychloroquine trial. He said no serious safety issues were identified among the patients taking it.
Agus of the PDPI said that clinicians could still use hydroxychloroquine to treat COVID-19 patients in Indonesia, as recent studies had found no meaningful clinical or statistical links between the drug and increased death rates or other side effects, such as fatal arrhythmia. He said, however, that the protocol panel would look into the matter further to decide whether to add the drug to the upated protocol.
President Joko “Jokowi” Widodo announced in late March that the government would procure millions of hydroxychloroquine pills, not long after United States President Donald Trump called the drug a potential "game changer".
