COVID-19 · Corticosteroids in COVID-19
Dexamethasone in Hospitalized Patients with Covid-19
| Design | Randomised, controlled, open-label adaptive platform trial |
|---|---|
| Treatment | Dexamethasone 6 mg once daily for up to 10 days |
| Control | Usual care |
| Population | 6425 patients hospitalised with COVID-19 |
| Follow-up | 28 days |
| Primary endpoint | 28-day all-cause mortality |
| Result | Death within 28 days occurred in 482 of 2104 (22.9%) on dexamethasone versus 1110 of 4321 (25.7%) on usual care — age-adjusted rate ratio 0.83 (95% CI 0.75 to 0.93, p<0.001). The benefit varied markedly by level of respiratory support: present in those receiving invasive ventilation or oxygen, absent in those receiving neither. |
| Secondary endpoints | Time to discharge, progression to invasive ventilation |
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.
The trial authors, in the published abstract
The most consequential result of the pandemic, and a demonstration that a large, simple, pragmatic platform trial can answer a question in months. The subgroup structure is the finding, not a caveat: benefit tracks the severity of respiratory failure, and there is a hint of harm in the mildest patients.
Horby P, Lim WS, Emberson JR, et al. Dexamethasone in Hospitalized Patients with Covid-19. N Engl J Med 2021 Feb 25;384(8):693-704.