Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report
By P. Horby, W. Lim, Jonathan R. Emberson, Marion Mafham, J. Bell, L. Linsell, N. Staplin, C. Brightling, A. Ustianowski, E. Elmahi and 16 more. medRxiv, 2020
3,268 citations recorded by the source corpus.
Background: Coronavirus disease 2019 (COVID-19) is associated with diffuse lung damage. Corticosteroids may modulate immune-mediated lung injury and reducing progression to respiratory failure and death. Methods: The Randomised Evaluation of COVID-19 therapy (RECOVERY) trial is a randomized, controlled, open-label, adaptive, platform trial comparing a range of possible treatments with usual care in patients hospitalized with COVID-19. We report the preliminary results for the comparison of dexamethasone 6 mg given once daily for up to ten days vs. usual care alone. The primary outcome was 28-day mortality. Results: 2104 patients randomly allocated to receive dexamethasone were compared with 4321 patients concurrently allocated to usual care. Overall, 454 (21.6%) patients allocated dexamethasone and 1065 (24.6%) patients allocated usual care died within 28 days (age-adjusted rate ratio [RR] 0.83; 95% confidence interval [CI] 0.74 to 0.92; P<0.001). The proportional and absolute mortality rate reductions varied significantly depending on level of respiratory support at randomization (test for trend p<0.001): Dexamethasone reduced deaths by one-third in patients receiving invasive mechanical ventilation (29.0% vs. 40.7%, RR 0.65 [95% CI 0.51 to 0.82]; p<0.001), by one-fifth in patients receiving oxygen without invasive mechanical ventilation (21.5% vs. 25.0%, RR 0.80 [95% CI 0.70 to 0.92]; p=0.002), but did not reduce mortality in patients not receiving respiratory support at randomization (17.0% vs. 13.2%, RR 1.22 [95% CI 0.93 to 1.61]; p=0.14). Conclusions: In patients hospitalized with COVID-19, dexamethasone reduced 28-day mortality among those receiving invasive mechanical ventilation or oxygen at randomization, but not among patients not receiving respiratory support.
Subfields: Infectious Diseases, Neurology, Pulmonary and Respiratory Medicine
View Paper: https://www.semanticscholar.org/paper/f37a84afa07094a3a536cfb18adf998cdd642eda
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Citations in the corpus
- COVID-19 and the human innate immune system (2021, background): “…shown to be beneficial, particularly in patients with severe disease courses where it reduced 28-day mortality in randomized clinical trials (RECOVERY Collaborative Group et al., 2021; Tomazini et al., 2020; WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group et al., 2020).”
- Effect of Tocilizumab vs Standard Care on Clinical Worsening in Patients Hospitalized With COVID-19 Pneumonia: A Randomized Clinical Trial. (2020, methodology): “Patients were randomized after a median (interquartile range) time from symptom onset of 8 (6-11) days.”
- Clinical characteristics and day-90 outcomes of 4244 critically ill adults with COVID-19: a prospective cohort study (2020, background): “Notably, 28-day mortality was 41% in the control care group of the RECOVERY trial, which showed that dexamethasone improved the survival of patients receiving invasive mechanical ventilation or oxygen at randomization [6].”
- Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19: The REMAP-CAP COVID-19 Corticosteroid Domain Randomized Clinical Trial. (2020, neutral): “Median (IQR) 18 (10-23) 17 (12-24) 15 (12-21)”
- Endothelial Dysfunction in Atherosclerotic Cardiovascular Diseases and Beyond: From Mechanism to Pharmacotherapies (2021, background): “Other emerging drugs with therapeutic potential include anticoagulant drugs (Paar et al., 2021), dexamethasone (Horby et al., 2021), canakinumab (an anti–IL-1b monoclonal antibody) (Ucciferri et al., 2020), adrecizumab (an anti-adrenomedullin antibody) (Karakas et al., 2020), and NLRP3 inflammasome…”