Dexamethasone in Hospitalized Patients with Covid-19
- 25 February 2021
- journal article
- research article
- Published by Massachusetts Medical Society in The New England Journal of Medicine
- Vol. 384 (8), 693-704
- https://doi.org/10.1056/nejmoa2021436
Abstract
BACKGROUND Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. METHODS In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the final results of this assessment. RESULTS A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.92 to 1.55). CONCLUSIONS In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.Funding Information
- United Kingdom Research and Innovation (MC_PC_19056)
- National Institute for Health Research (MC_PC_19056)
This publication has 35 references indexed in Scilit:
- Modernising epidemic science: enabling patient-centred research during epidemicsBMC Medicine, 2016
- Corticosteroid Therapy for Patients Hospitalized With Community-Acquired PneumoniaAnnals of Internal Medicine, 2015
- Influenza — Time to Target the Host?The New England Journal of Medicine, 2013
- Viral Loads and Duration of Viral Shedding in Adult Patients Hospitalized with InfluenzaThe Journal of Infectious Diseases, 2009
- SARS: Systematic Review of Treatment EffectsPLoS Medicine, 2006
- Fatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemiaNature Medicine, 2006
- Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patientsJournal of Clinical Virology, 2004
- Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndromeThe Lancet, 2004
- Plasma inflammatory cytokines and chemokines in severe acute respiratory syndromeClinical and Experimental Immunology, 2004
- Why do we need some large, simple randomized trials?Statistics in Medicine, 1984