When and How Could Dexamethasone Be Useful in a COVID-19 Infection?

More details have emerged on the group of COVID-19 patients who received dexamethasone in the RECOVERY trial.

These data, published as a preliminary report in the New England Journal of Medicine (NEJM), suggest that dexamethasone could reduce mortality in cases when infection effects are mainly derived from immunopathological elements in patients requiring mechanical ventilation or at least supplementary oxygen.

On the other hand, there was no benefit in patients who, at the time of randomization, had not required any respiratory support.

The RECOVERY trial (conducted by researchers from the University of Oxford) is testing several treatments for patients with COVID-19.

In total, 2104 patients were randomized to (oral or intravenous) dexamethasone 6 mg/day for 10 days and 4321 to the standard of care. The preliminary report published in NEJM shows that the 28-day death rate was 22.9% in the dexamethasone group compared with 25.7% in the usual-care group (risk ratio [RR]: 0.83; 95% confidence interval [CI]: 0.75-0.93).

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The benefit was restricted to patients requiring mechanical ventilation (29.3% vs. 41.4%; RR: 0.64; 95% CI: 0.51-0.81) or supplementary oxygen (23.3% vs. 26.2%; RR: 0.82; 95% CI: 0.72-0.94).

Patients who did not require any kind of respiratory support experienced no benefit with dexamethasone; there even were results consistent with possible harm in this subgroup.

The randomization was done a median of 8-9 days after symptom onset and within 2 days of hospital admission.

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The benefit of dexamethasone observed after the first week of symptom onset suggests that the drug is useful at that disease stage when the main problem is the inflammatory response as opposed to viral replication.

This study also randomized patients to receive lopinavir/ritonavir or hydroxychloroquine, but that has now been stopped due to a lack of benefit or harm. The trial continues analyzing patients who received azithromycin, tocilizumab, or convalescent plasma.

Título original:Dexamethasone in hospitalized patients with COVID-19—preliminary report.

Referencia: The RECOVERY Collaborative Group. N Engl J Med. 2020 Jul 17. doi: 10.1056/NEJMoa2021436.

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