Demand for dexamethasone soars after promising findings in UK

Weekly demand in the U.S. is up more than 600%.

June 26, 2020, 2:06 PM

Last week, a study in the U.K. found that dexamethasone, a common steroid, increased survival in severely ill COVID-19 patients who needed help breathing.

Within a few days of that report, weekly demand for dexamethasone increased by over 600% in the U.S., according to data from the health care performance improvement company Vizient. That figure tracks with what's happening globally, as World Health Organization Director-General Tedros Adhanom Ghebreyesus said demand for the drug "surged" in the wake of the U.K. trials.

Dexamethasone now represents the second pharmaceutical treatment that has been demonstrated to work for COVID-19. An antiviral drug, remdesivir, was shown to help hospitalized patients leave the hospital sooner.

In the wake of positive data on dexamethasone, the steroid swiftly was approved by the U.K. government for use in COVID-19 patients.

In the United States, Secretary of Health and Human Services Alex Azar said on Friday the drug has been added to treatment guidelines, and the Infectious Disease Society of America Thursday announced that doctors should consider using the steroid in hospitalized patients with COVID-19.

Even given the recent surge in demand, experts are saying there's no immediate threat of a drug shortage.

Although promising, dexamethasone only was demonstrated to help patients who have severe COVID-19 and need help breathing, through ventilation or oxygen assistance. The steroid treatment doesn't help people with a more mild COVID-19 illness, which accounts for most cases. Nor has dexamethasone been shown to prevent COVID-19 infections.

PHOTO: A close-up of a box of Dexamethasone tablets in a pharmacy on June 16, 2020, in Cardiff, United Kingdom.
A close-up of a box of Dexamethasone tablets in a pharmacy on June 16, 2020, in Cardiff, United Kingdom. Results of a trial announced today have shown that Dexamethasone, a cheap and widely used steroid drug which is used to reduce inflammation, reduced death rates by around a third in the most severely ill COVID-19 patients who were admitted to the hospital.
Matthew Horwood/Getty Images

In fact, it may not be safe to use in patients with mild illness. In the U.K. study, dexamethasone "non-significantly increases death if used in milder patients with COVID-19," said Dr. Todd Ellerin, director of Infectious Diseases at South Shore Health. He warned that for patients with milder COVID-19 illness "the risks of the medication likely outweigh the benefits."

Even in critically ill novel coronavirus patients, there's still some caution surrounding the use of dexamethasone.

"We have many, many papers showing both benefit and harm for steroids for critically ill patients, so many doctors may want to wait for some additional data," said Erin Fox, a drug shortage expert at the University of Utah.

According to Fox, there have been shortages of certain forms of injectable dexamethasone since 2011, where "in some cases you couldn't get the exact size or strength that you wanted."

The good news is that both intravenous and oral dexamethasone were used in the U.K. study, and either can be used to help critically ill COVID-19 patients.

"Dexamethasone is widely used in every hospital," Fox added. "Even small rural hospitals would keep some in stock."

Steven Lucio, vice president of pharmacy solutions at Vizient, said, "Hopefully, we will be able to manage the supply situation," as there are multiple suppliers of both injectable and oral dexamethasone.

That said, the drug still should be administered judiciously, noted Ellerin, adding, "We have to be careful not to hoard dexamethasone, or that will almost guarantee we will have a shortage."

This situation is in contrast to concern over increasing demand for oxygen concentrators, a critical resource for treating severe COVID-19 cases that's outpacing supply. Tedros has noted how 80% of the market is controlled by just a few companies.

Flattening the curve, needing fewer supplies for treatments, is perhaps the surest way to prevent shortages of critical supplies, noted Dr. Rajesh T. Gandhi, a fellow of the infectious diseases society of America.

With frequent hand-washing, mask wearing and social distancing, Gandhi added, "We know how to prevent these cases."

Hassal Lee, a neuroscience Ph.D. and student doctor at the University of Cambridge, is a contributor to the ABC News Medical Unit. Sony Salzman is the unit's coordinating producer.

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