Explained Ideas: Why dexamethasone, and not remdesivir, deserves India’s attention for Covid treatment

Dexamethasone is proving to be far more effective in reducing the risk of death and can be made readily available to patients at affordable prices, writes Ganesan Karthikeyan.




Reliable information is key to tackling any outbreak and nowhere is it more crucial than in the management of the ongoing pandemic, says Ganesan Karthikeyan, a professor of cardiology at the All India Institute of Medical Sciences, New Delhi.

However, the sheer volume and variety of information being made available make it difficult to judge which bits are true and which hyperbole.

“The consequence of all this is impaired judgement, misplaced beliefs and distorted priorities. The run on pharmacies for hydroxychloroquine (triggered by mere speculations) that we witnessed a few weeks ago is a prime example,” writes Karthikeyan.

Another similar irrational obsession is gripping India, he writes. “Almost every television channel and newspaper seems to be gushing over the miraculous effects of the antiviral drug remdesivir, and that other “cure”, plasma therapy. Barring a few honourable exceptions, even some of the so-called experts are not hesitant to overstate their benefits”.

Level-headed advisory from institutions like the ICMR, that plasma therapy is still an experimental treatment, are lost in the din. So, it is very likely that people are, in general, convinced that the only two currently available treatments for COVID-19 are plasma therapy and remdesivir.

But, Karthikeyan argues that a study of dexamethasone in the United Kingdom deserves prominence.

For one, this is the first study to show an unequivocal, and large benefit in sick patients with COVID-19, on the outcomes that matter most — the risk of death and the risk of needing ventilator support.

Second, dexamethasone is cheap and readily available, with several “branded generics” available in the Indian market.

“A course of treatment at the prescribed dose would cost less than Rs 10 per patient. On the other hand, remdesivir, even the brands marketed by Indian companies, would cost tens of thousands of rupees per course,” writes Karthikeyan.

In the absence of adequate information, the price of a commodity serves as an indicator of quality for the consumer.

“Information asymmetry is most acute in healthcare, with the added disadvantage that the providers of care have far greater access to, and understanding of the information. It is naïve to expect that the pharmaceutical industry and for-profit healthcare providers will fill this information gap to their detriment,” he says.

“The responsibility to rescue the media, the general public and our policymakers from the ‘remdesivir effect’, therefore, falls squarely upon physicians and public health agencies,” he concludes.

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