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…
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
outcome was all
cause mortality at 28 days. There were lots of prespecified secondary
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.
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
RECOVERY Collaborative Group, Dexamethasone in Hospitalized Patients with
COVID-19. N Engl J Med 2021;384:693-704. [link to full text article]