Mortality Rates in Hospitalized COVID-19 Patients on Dexamethasone Lower VS Usual Care

July 20, 2020

This was seen in patients who were receiving either invasive mechanical ventilation or oxygen.

Hospitalized COVID-19 patients who were on invasive mechanical ventilation or oxygen and taking dexamethasone experienced a low mortality rate compared to those who were on a usual care regimen.

The findings were reported in The New England Journal of Medicine.

“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,” investigators wrote.

These results were reported from the RECOVERY trial, which was developed to look at treatments in patients hospitalized with COVID-19 at 176 medical institutions in the UK.

In the study, 2104 patients were given dexamethasone and 4321 received usual care. Patients were randomly assigned to either receive oral or intravenous dexamethasone, 6 mg once daily for up to 10 days or to receive usual care alone.

In terms of results, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001).

It is important to note, the proportional and absolute between-group differences in mortality varied considerably depending on the level of respiratory support that the patients were receiving.

In the group taking dexamethasone, the mortality rate was lower than that of the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94).

However, these results were not witnessed in those who were receiving no respiratory support. In those groups, it was 17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.91 to 1.55).

In addition, for patients with symptoms for more than 7 days saw a great mortality benefit when taking dexamethasone vs. those with a more recent onset of symptoms.

And, in the patients who were not on invasive mechanical ventilation and taking dexamethasone, that group saw a lower progression to ventilation or death vs. the usual care group (risk ratio, 0.92; 95% CI, 0.84 to 1.01).

“The greater mortality benefit of dexamethasone in patients with COVID-19 who are receiving respiratory support and among those recruited after the first week of their illness suggests that at that stage the disease may be dominated by immunopathological elements, with active viral replication playing a secondary role,” the investigators wrote. “This hypothesis would caution against extrapolation of the effect of dexamethasone in patients with COVID-19 to patients with other viral respiratory diseases with a different natural history.”