A steroid that was in shortage before the pandemic has gotten more scarce since researchers reported it can improve the survival rate of COVID-19 patients.
A study from the University of Oxford published June 16 shows dexamethasone reduced the risk of death by up to one-third among coronavirus patients on ventilators.
Sixteen dosages of the inexpensive steroid had been on the U.S. Food and Drug Administration’s shortage list since 2019. Half of the shortages were blamed on demand, and manufacturers attributed the others to manufacturing delays and other reasons.
Since the promising dexamethasone study was published, manufacturers have sent updates to the FDA list, blaming 15 of the 16 shortages on increased demand.
“Dexamethasone is the first drug to be shown to improve survival in COVID-19. This is an extremely welcome result,” Peter Horby, one of the chief investigators for the trial, said in a statement. “The survival benefit is clear and large in those patients who are sick enough to require oxygen treatment, so dexamethasone should now become standard of care in these patients.”
According to the FDA data, the specific form of the drug in shortage is generic dexamethasone sodium phosphate injection from five manufacturers.
Dexamethasone can be taken orally, but its injectable form is the most popular version in an emergency room, according to Megan Ranney, an emergency physician at the Rhode Island Hospital in Providence.
“We use it on a daily basis in the emergency department to treat a wide variety of conditions ranging from croup to allergies to life-threatening swelling in the brain,” Ranney said.
Dexamethasone can be used in multiple situations, for both ventilated and nonventilated patients. Jeremy Faust, an emergency room doctor at Brigham and Women’s Hospital, described its uses as “remarkably varied and vast.”
Before the release of the University of Oxford study, Ranney said, she used the drug to help sick patients avoid ventilation. Now, Ranney said, she would reserve the use of dexamethasone for “really sick” COVID-19 patients who need intensive care.
She cited the supply shortage and a call last week by the head of the World Health Organization’s emergencies program to prioritize the most serious cases.
Ranney said she remembered the injectable dexamethasone was on the FDA’s shortage list and pharmacists had suggested using alternative formulations or medications. Four of the five manufacturers listing the steroid as in shortage cited increased demand.
Since the coronavirus pandemic began, skyrocketing demand has been cited as the major cause of other drug shortages. Of the 28 generics added to the FDA’s shortage list this year, 17 were related to the COVID-19 crisis, according to doctors.
According to Vizient, a group purchasing organization that serves about 3,000 hospitals in the USA, demand for dexamethasone for the third week of June increased by 610% compared with the demand for the second week of June.
Though the drug is touted as a “breakthrough” treatment for coronavirus, doctors across the country voiced their worries that people might self-medicate.
Faheem Younus, who oversees the Department of Infectious diseases at the University of Maryland medical centers, posted his concerns on Twitter one day after the U.K. study published: “Single study. Details awaited. Benefits will be debated and need to be validated. Too soon to consider this the ‘breakthrough.’
“DON’T SELF MEDICATE,” he tweeted.
Dian Zhang is a data journalist for USA TODAY. Follow Dian on Twitter: @dian_zhang_