"Dexamethasone in Hospitalized Patients with Covid-19". The New England Journal of Medicine.

Clinical Question:

Does the addition of dexamethasone to usual care improve 28-day mortality in patients hospitalized with Covid-19?

Bottom Line:

In hospitalized patients with Covid-19, dexamethasone resulted in lower 28-day mortality among those who were receiving invasive mechanical ventilation or oxygen alone but not among patients without respiratory support.

Major Points:

Severe Covid-19 can lead to respiratory failure and death, potentially related to the host's immune response. The RECOVERY trial evaluated the mortality benefit of dexamethasone, a glucocorticoid, in hospitalized Covid-19 patients requiring respiratory support. The findings demonstrate that dexamethasone reduces 28-day mortality in patients under invasive mechanical ventilation or oxygen therapy but is not beneficial for patients not receiving respiratory support and could potentially be harmful.

Guidelines:

Updated guidelines recommend the use of glucocorticoids in patients hospitalized with Covid-19 requiring oxygen with or without ventilatory support.

Design:

Multicenter, controlled, open-label trial

Population:

6,425 patients hospitalized with Covid-19; 2,104 in the dexamethasone group and 4,321 in the usual care group.

Interventions:

Patients were randomly assigned to receive usual care plus 6 mg of dexamethasone once daily for up to 10 days or usual care alone.

Outcomes:

The primary outcome was 28-day mortality. Secondary outcomes included hospital discharge within 28 days and progression to invasive mechanical ventilation or death among patients not on invasive mechanical ventilation at randomization.

Criticisms:

- Open-label design without placebo control
- Dexamethasone not beneficial for patients without respiratory support

Funding:

Funded by the Medical Research Council, National Institute for Health Research, and others.

Further Reading:

Original publication in The New England Journal of Medicine