The U.S. Meals and Drug Administration (FDA) added dexamethasone, a robust steroid, to the company’s drug shortages record on Feb. 8, 2019. Regardless of persistent and ongoing shortages, President Trump obtained dexamethasone whereas present process therapy for COVID-19 in early October.
Is that this an instance of unfair preferential therapy? No. Though the dexamethasone scarcity is ongoing, the drug is obtainable and “provides proceed to enhance,” in accordance with an electronic mail from FDA press officer Jeremy Kahn.
However will provides be capable to hold tempo with demand as COVID-19 infections and hospitalizations proceed to rise within the Midwest and different components of the USA? In spite of everything, demand for hydroxychloroquine spiked earlier this 12 months after Mr. Trump touted it as a doable treatment for COVID-19, resulting in shortages which have left some arthritis and lupus sufferers with out the drug they’ve used for years to regulate signs.
The dexamethasone scarcity just isn’t more likely to trigger comparable issues, mentioned Michael Ganio, PharmD, senior director of pharmacy apply and high quality of the American Society of Well being System Pharmacists (ASHP).
“There is no such thing as a actual substitute for hydroxychloroquine, however now we have options for dexamethasone,” Dr. Ganio mentioned.
Dexamethasone Scarcity Pre-Dated COVID
When the FDA first famous the dexamethasone scarcity in early 2019, nobody had but heard of SARS-CoV-2, the novel coronavirus that has since triggered a lot loss of life, incapacity and international upheaval. A corticosteroid, dexamethasone is used primarily to regulate irritation throughout the physique attributable to ailments and medical circumstances comparable to bronchial asthma and allergic reactions.
In response to Dr. Ganio, the dexamethasone scarcity, like most drug shortages, was not attributable to elevated demand for the drug however by disruptions within the manufacturing course of. Oral dexamethasone provides have been unaffected; solely the injectable model, which is technically tougher to fabricate, was in brief provide.
Dexamethasone Demand Spiked After Examine Reveals It Can Lower COVID-Associated Deaths
As a result of dexamethasone decreases irritation, scientists suspected it is perhaps useful in treating COVID-19, because the illness may cause irritation all through the physique. In a single research, researchers in the UK gave greater than 2,100 sufferers dexamethasone (both orally or by injection) and in contrast their outcomes to sufferers receiving traditional therapy. Hospitalized sufferers who obtained dexamethasone – an inexpensive, well-known drug – have been extra more likely to survive than those that didn’t. The drug decreased deaths by one-third in patients on ventilators.
On June 16, the day the research knowledge was launched, hospital orders for dexamethasone elevated 183%. Inside per week, demand had jumped greater than 600%. By mid-June, hospitals weren’t reliably receiving ordered provides of injectable dexamethasone.
In response to the FDA’s web site, 5 completely different firms produce injectable dexamethasone, and, like all industries, they virtually definitely skilled provide chain and labor disruptions throughout COVID-related lockdowns.
Acceptable Substitutes are Extensively Accessible
“One benefit of steroids is that you could take them orally, and that’s principally as efficient as in the event you administer them through injection,” Dr. Ganio mentioned.
The pill type of dexamethasone stays obtainable and is an efficient alternative for a lot of sufferers – in truth, it’s the shape utilized by most sufferers who depend on dexamethasone as a therapy for bronchial asthma or autoimmune issues.
After all, severely sick COVID-19 sufferers on ventilators can’t swallow oral remedy. Nonetheless, clinicians have a spread of therapy choices, together with prednisone, methylprednisolone and hydrocortisone, three different types of steroids.
“The Nationwide Institutes of Well being pointers for the therapy of COVID-10 state that ‘If dexamethasone just isn’t obtainable, an alternate corticosteroid comparable to prednisone, methylprednisolone or hydrocortisone can be used,’” Dr. Ganio mentioned.
You received’t possible get a helicopter experience to Walter Reed Medical Heart in the event you contract COVID-19, however odds are good that you simply’ll obtain steroid therapy in case your situation warrants it.
Jennifer L.W. Fink, RN, BSN, is a Registered Nurse-turned-writer. She’s additionally the creator of BuildingBoys.net and co-creator/co-host of the podcast On Boys: Real Talk about Parenting, Teaching & Reaching Tomorrow’s Men .