Tuesday 23 November 2021

Dexamethasone in hospitalized patients with COVID-19

Prior to the publication of this study, there was quite a lot of debate about the efficacy of dexamethasone for hospitalized patients with COVID. 

But not now…

The RECOVERY trial was designed to quickly look at many potential treatments for COVID. A whopping 176 NHS organizations in the UK were involved and with no shortage of patients to enroll.

Hospitalized patients with COVID were randomized to get either 6mg of dexamethasone daily for 10 days or usual care alone.

Primary outcome was all cause mortality at 28 days. There were lots of prespecified secondary outcomes.

6425 patients were recruited from March to June 2020. Overall, 22.9% of patients in the dexamethasone group died vs. 25.7% in the usual care arm. Absolute difference of 2.8% for a number needed to treat (NNT) of 36.

But the benefit seemed to be best in the sickest patients that were ventilated; NNT 8. There was a trend towards harm in the healthier group not requiring oxygen.

There are some limitations to this study, the biggest being our care of COVID has changed since it was conducted, care was not standardized, and this was an unvaccinated cohort. Nevertheless, it was generally well performed and (for now) it is considered practice changing.

Dexamethasone is no “magic bullet” but another piece of the puzzle that might provide some benefit to those sick enough to be hospitalized with COVID. However, no therapies have come even close to the benefits we see with vaccination.

Get ‘em all vaccinated!



The RECOVERY Collaborative Group, Dexamethasone in Hospitalized Patients with COVID-19. N Engl J Med 2021;384:693-704. [link to full text article]