UMEM Educational Pearls

Title: Dexamethasone: Improving Mortality in COVID-19?

Keywords: dexamethasone, steroids, respiratory failure, COVID-19, SARS-CoV-2, RECOVERY (PubMed Search)

Posted: 7/14/2020 by Kami Windsor, MD
Click here to contact Kami Windsor, MD

The RECOVERY (Randomized Evaluation of COVid-19 thERapY) investigators recently published a non-peer reviewed article on their findings utilizing dexamethasone to treat patients with COVID-19.

Rx: Dexamethasone 6mg daily* x 10 days (PO or IV) *or steroid equivalent

2104 in the dexamethasone group vs 4321 in the “usual care” group
Did not exclude children or pregnant/breastfeeding mothers
Follow-up at 28 days, hospital discharge, or death

Primary outcome: All-cause mortality at 28-days

Secondary outcomes:

Major arrhythmia
Time to discharge from hospital
Duration of mechanical ventilation
Need for renal replacement therapy
In patients not ventilated at enrollment, need for intubation/ECMO & death

Results:

Decrease in overall mortality at 28-days with 3% absolute risk reduction.
- NNT of 25 in patients requiring O2, HFNC, or NIV
- NNT of 8 in patients requiring invasive mechanical ventilation
More mortality benefit seen the higher the respiratory support required, with no benefit and apparent trend towards increased mortality in the group not requiring any respiratory support at all.
When stratified by symptoms < or > 7 days, mortality benefit only seen in the >7 days group (which was more of the ventilated patients).
Less progression to intubation, shorter hospital duration, greater likelihood of hospital discharge.

Limitations:

Not yet peer-reviewed, haven't seen all the data, additional analyses could be helpful in determining if treatment effect is real
Unblinded study
7% of control group received dexamethasone

Bottom Line: Strongly consider admininstering dexamethasone to your patients with known COVID-19 who require respiratory support, and look for the peer-reviewed publication from the RECOVERY Trial investigators.

References

Horby P, Lim WS, Emberson et al. Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report. https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1 (Accessed July 14^th, 2020)