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In patients requiring conventional oxygen support, giving a higher dose of dexamethasone raised risk for death compared with standard-dose corticosteroids.
In patients hospitalized with COVID-19 who require oxygen support, dexamethasone (6 mg daily for 10 days) reduces mortality and is standard of care. Now, in a randomized open-label trial, the RECOVERY group compared high-dose dexamethasone (20 mg daily for 5 days followed by 10 mg daily for 5 more days) to standard-dose dexamethasone in 1272 hospitalized patients who were hypoxic but did not require ventilatory support.
Participants were enrolled between May 2021 and May 2022. About 60% were in Asia (mostly Nepal) and 40% were in the U.K. Approximately half had received a COVID-19 vaccine. Almost all participants were receiving conventional oxygen support at randomization. The high-dose and standard-dose dexamethasone groups had similar use rates for other treatments (remdesivir, 34%; tocilizumab, 8–9%). The main findings are as follows:
- Mortality within 28 days was higher in the high-dose group than the standard-dose group: 19% vs. 12%.
- Rates of non-COVID-19 pneumonia and hyperglycemia were increased in the high-dose group.
Other studies have suggested, but not proven, that higher doses of corticosteroids may be beneficial in people who are critically ill with COVID-19 — and the RECOVERY group continues to study this issue in those who require ventilatory support (noninvasive or mechanical ventilation). For now, however, the data indicate that we should use standard doses of dexamethasone in people hospitalized with COVID-19 who require oxygen support.
Dr. Gandhi is a member of the NIH and Infectious Diseases Society of America COVID-19 Treatment Guidelines Panels. The opinions in this review are his and not necessarily those of the Panels.