Dexamethasone lowers 28-day mortality in patients hospitalized with COVID-19 who are receiving invasive mechanical ventilation or oxygenation alone, a team of British researchers have confirmed in a preliminary report on their study published online in the New England Journal of Medicine.
Peter Horby, M.B.B.S., from the University of Oxford in the United Kingdom, and colleagues conducted an open-label trial comparing possible treatments in patients who were hospitalized with COVID-19. Patients were randomly assigned to receive either dexamethasone for up to 10 days (2,104 patients) or usual care (4,321 patients).
The researchers found that within 28 days after randomization, 22.9 and 25.7 percent of patients in the dexamethasone group and the usual care group, respectively, died (age-adjusted rate ratio, 0.83; 95 percent confidence interval [CI], 0.75 to 0.93; P < 0.001).
There was considerable variation noted in the proportional and absolute between-group differences in mortality according to the level of respiratory support the patients were receiving.
The incidence of death was lower in the dexamethasone versus the usual care group among patients receiving invasive mechanical ventilation (29.3 versus 41.4 percent; rate ratio, 0.64; 95 percent CI, 0.51 to 0.81) and for those receiving oxygen without invasive mechanical ventilation (23.3 versus 26.2 percent; rate ratio, 0.82; 95 percent CI, 0.72 to 0.94) but not among those receiving no respiratory support (17.8 versus 14.0 percent; rate ratio, 1.19; 95 percent CI, 0.91 to 1.55).
“Guidelines issued by the U.K. chief medical officers and by the National Institutes of Health in the United States have already been updated to recommend the use of glucocorticoids in patients hospitalized with COVID-19,” the authors noted.
REFERENCE: Horby et al: Dexamethasone in Hospitalized Patients with Covid-19 — Preliminary Report; https://www.nejm.org/doi/full/10.1056/NEJMoa2021436