Coronavirus Special Update #5 - Dexamethasone Use in COVID-19 Patients

Dexamethasone Use in Hospitalized COVID-19

Glucocorticosteroids have been used for previous infections similar to COVID-19 like SARS, MERS, severe influenza and community acquired pneumonia
Glucocosticoidsteroids may help regulate inflammatory mediated lung injury
Dexamethasone significantly decreased 20-day mortality in patients receiving oxygen
Benefit not seen in patients not receiving respiratory support at time of randomization.

Methods

176 national Health Service Organizations in United Kingdom
Clinically suspected or laboratory confirmed SARS-CoV-2 infection
Randomization ratio of 2:1 (standard care to dexamethasone)
Dexamethasone 6 mg oral or IV once daily for 10 days or discharge, whichever occurs first
Administration of other available treatments evaluated in the trial

Outcome Measures

Primary Outcome: mortality as a single follow up, to be completed upon:
- Discharge
- Death
- 28 days after randomization
Secondary Outcomes: Time to:
- Hospital discharge, death, or invasive mechanical ventilation if not being received at time of randomization

RESULTS

March 19, 2020 to June 8, 2020
6,425 randomized patients (2,104 dexamethasone/4,321 standard care), 64% male
Median duration of dexamethasone therapy was 7 days
- Standard care group: 8% received dexamethasone
Dexamethasone resulted in statistically significant 28-day mortality reductions in:
- Patients receiving invasive mechanical ventilation or receiving oxygen only
No benefit observed in patients not receiving oxygen at time of randomization

Dexamethasone also provided a greater 28-day mortality benefit in patients
- Patients less than 70 years of age
- With symptoms greater than 7 days

·No clear benefit of dexamethasone in patients who were not receiving any respiratory support at randomization on:
- Discharge from the hospital alive
- Ultimately needing mechanical ventilation
- Death

Dexamethasone up to 10 days, reduces 28-day mortality in COVID-19 patients receiving oxygen support at randomization.
Benefit is also seen in patients being treated greater than 7 days after symptom onset, indicating the increased likelihood of inflammatory lung disease.
There is no evidence of any benefit to COVID-19 patients not receiving respiratory support and may potentially be harmful
Contact me to learn more about the use of dexamethasone in hospitalized COVID-19 patients.