Research suggests dexamethasone could benefit patients hospitalized with COVID-19

Early administration of dexamethasone in patients hospitalized with COVID-19 was found to reduce a composite outcome of in-hospital mortality or hospice discharge for patients receiving supplemental oxygen, mechanical ventilation, or extracorporeal membrane oxygenation.

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Despite ongoing research efforts and thousands of trials exploring new and repurposed drugs, few effective treatments are available for patients hospitalized with COVID-19. Current National Institutes of Health guidelines recommend systemic corticosteroids as the cornerstone of treatment for patients hospitalized with COVID-19 who require supplemental oxygen, largely based on the RECOVERY trial.

In the RECOVERY study, daily administration of 6 mg dexamethasone for up to 10 days was associated with a reduction in 28-day mortality in patients receiving oxygen alone or mechanical ventilation. Although the RECOVERY platform had a large sample size and helped inform the clinical management of COVID-19, the trial was notably an open-label study with no placebo group and no defined standard of care at the time.

Several other smaller clinical trials with dexamethasone and other systemic corticosteroids have found benefit but reported different effect sizes. For this reason, the authors of the present study aimed to conduct a large, national, multicenter cohort analysis to examine and detail the clinical use of dexamethasone in hospitalized patients with COVID-19 and to explore the adjusted association. propensity with hospital outcomes. .

Study data was compiled by the COVID-19 Consortium of HCA Healthcare and Academic for Research Generation, including electronic health records of patients hospitalized with laboratory-confirmed SARS-CoV-2 infection between the 1st July 2020 and October 31, 2021, at 156 facilities in the United States. Adult patients aged 18 and older were selected if they had been hospitalized and alive for at least 48 hours with a diagnosis code for COVID-19 as well as respiratory illness during the same encounter.

After application of the inclusion and exclusion criteria, 80,699 patients were included with a median age of 64 years. They were divided into 4 cohorts, with 13,040 (16.2%) not requiring supplemental oxygen or respiratory support; 56,368 (69.8%) requiring supplemental oxygen; 7,618 (9.4%) requiring nasal intermittent positive pressure ventilation (NPPV); and 3673 (4.6%) requiring mechanical ventilation or extracorporeal membrane oxygenation (ECMO).

After overlap weighting, investigators found that all-cause inpatient mortality or hospice discharge was lower for patients who received dexamethasone within 48 hours of admission or increased intake. oxygen in the supplemental oxygen group and in the mechanical ventilation or ECMO group. In contrast, all-cause inpatient mortality or hospice discharge was not lower for patients who received dexamethasone in the no supplemental oxygen group and in the NIPPV group.

In a subgroup analysis among patients receiving supplemental oxygen, improvement in primary outcome was seen in patients over the age of 70, white patients, non-Hispanic patients, diabetic patients, those with did not receive remdesivir, patients with a higher Charlson Comorbidity Index (CCI), and patients receiving low-flow supplemental oxygen. Among patients requiring NIPPV, improvement in primary outcome was seen in white patients and those with higher CCI scores.

Finally, among patients requiring mechanical ventilation and/or ECMO, improvement in primary outcome was seen in younger patients, non-Hispanic patients, and those who received remdesivir.

Based on these results, the researchers concluded that early administration of dexamethasone was associated with improved mortality or hospice discharge in patients requiring supplemental oxygen or mechanical ventilation and/or ECMO. . Future research should continue to explore patient subgroups to help inform and individualize COVID-19 therapy.

REFERENCE

Mourad A, Thibault D, Holland TL, Yang S, et al. Dexamethasone for hospitalized patients with COVID-19 in a national cohort. JAMA Netw Open 2023;6(4):e238516. doi:10.1001/jamanetworkopen.2023.8516