Original Article
Comparison of Standard and Extended Dexamethasone Duration on Mortality in Patients with Severe COVID-19
Abstract
Objectives: Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19.Methods: A multicenter retrospective cohort study was conducted from January 2021 to December 2021. All of the consecutive patients with severe COVID-19 receiving 6 mg/day dexamethasone were eligible for inclusion. The primary outcome was the incidence of in-hospital mortality for patients treated with dexamethasone 6 mg/day for the standard duration of 10 days versus an extended duration of >10 days.
Results: A total of 1294 patients met the inclusion criteria: 803 received the standard duration of dexamethasone and 491 received the extended duration. The incidence of in-hospital mortality was significantly higher (P = 0.003) in the extended duration group (36.5%) compared with the standard duration group (28.5%), with no significant difference in in-hospital major adverse cardiac events (16.1% for extended vs 13.2% for the standard duration; P = 0.15).
Conclusions: The results show that extended duration of dexamethasone compared with standard duration is associated with a significant increase in in-hospital mortality in patients with severe COVID-19. These findings need to be confirmed in well-designed and performed randomized controlled trials.
Posted in: Infectious Disease146
This content is limited to qualifying members.
Existing members, please login first
If you have an existing account please login now to access this article or view purchase options.
Purchase only this article ($25)
Create a free account, then purchase this article to download or access it online for 24 hours.
Purchase an SMJ online subscription ($75)
Create a free account, then purchase a subscription to get complete access to all articles for a full year.
Purchase a membership plan (fees vary)
Premium members can access all articles plus recieve many more benefits. View all membership plans and benefit packages.
References
1. Li H, Yan B, Gao R, et al. Effectiveness of corticosteroids to treat severe COVID-19: a systematic review and meta-analysis of prospective studies. Int Immunopharmacol 2021;100: 108121.
2. Ye Z, Wang Y, Colunga-Lozano LE, et al.Efficacy and safety of corticosteroids inCOVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis. CMAJ 2020;192:E756–E767.
3. Group RC, Horby P, Lim WS, et al. Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 2021;384:693–704.
4. AlQahtani H, AlBilal S, Mahmoud E, et al. Outcomes associated with tocilizumab with or without corticosteroid versus dexamethasone for treatment of patients with severe to critical COVID-19 pneumonia. J Infect Public Health 2022;15:36–41.
5. Mathur P, Kottilil S. Immunomodulatory therapies for COVID-19. Front Med (Lausanne) 2022;9:921452.
6. Bhimraj A, Morgan RL, Shumaker AH, et al. Infectious Diseases Society of America guidelines on the treatment and management of patients with COVID-19 (September 2022). Clin Infect Dis 2024;78:e250–e349.
7. Jamil Z, Almajhdi FN, Khalid S, et al. Comparison of low-versus high-dose steroids in the clinical outcome of hospitalized COVID-19 patients. Antibiotics (Basel) 2021;10:1510.
8. Salton F, Confalonieri P, Centanni S, et al. Prolonged higher dose methylprednisolone versus conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS). EurRespirJ2023;61:2201514.
9. Toroghi N, Abbasian L, Nourian A, et al. Comparing efficacy and safety of different doses of dexamethasone in the treatment of COVID-19: a three-arm randomized clinical trial. Pharmacol Rep 2022;74:229–240.
10. Chaudhuri D, Sasaki K, Karkar A, et al. Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis. Intensive Care Med 2021;47:521–537.
11. Vandenbroucke JP, von Elm E, Altman DG, et al. Strengthening the Reporting of Observational Studies in Epidemiology (STROBE): explanation and elaboration. Int J Surg 2014;12:1500–1524.
12. Salton F, Confalonieri P, Meduri GU, et al.Prolonged low-dose methylprednisolone in patients with severe COVID-19 pneumonia. Open Forum Infect Dis 2020;7:ofaa421.
13. Rubio-Rivas M, Mora-Lujan JM, Formiga F, et al. WHO ordinal scale and inflammation risk categories in COVID-19.Comparativestudyofthe severity scales. J Gen Intern Med2022;37: 1980–1987.
14. Prasad RN, McIntyre M, Guha A, et al. Cardiovascular event reporting in modern cancer radiation therapy trials. Adv Radiat Oncol 2022;7:100888.
15. Yu WC, Hui DS, Chan-Yeung M. Antiviral agents and corticosteroids in the treatment of severe acute respiratory syndrome (SARS). Thorax 2004;59:643–645.
16. Sagris M, Theofilis P, Antonopoulos AS, et al. Inflammatory mechanisms in COVID-19 and atherosclerosis: current pharmaceutical perspectives. IntJMolSci2021;22:6607.
17. Narum S, Westergren T, Klemp M. Corticosteroids and risk of gastrointestinal bleeding: a systematic review and meta-analysis. BMJ Open 2014;4:e004587.
18. Makker J, Mantri N, Patel HK, et al. The incidence and mortality impact of gastrointestinal bleeding in hospitalized COVID-19 patients. Clin Exp Gastroenterol 2021;14:405–411.
19. Kyriacou DN, Lewis RJ. Confounding by indication in clinical research. JAMA 2016;316: 1818–1819.
20. Grady D, Redberg RF. Less is more: how less health care can result in better health. Arch Intern Med 2010;170:749–750.
