High-Dose vs Low-Dose Dexamethasone in Patients With Covid-19 in a Tertiary Hospital in Western Honduras

Montalvan, Eleazar; Carcamo, Balduino; Palacion, Dairy; Rivera, Shery; Estévez, R.J. Zabalza; Norwood, Dalton A.; Pineda, M.T.; Ordoñez, Jaen Carlos Cagua; Garner, Orlando

doi:10.1016/j.chest.2021.07.1027

Cited by 4 publications

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“…Published between 2020 and 2023, these studies collectively involved 5721 participants and were all RCTs. Among them, 15 studies [ 19 – 33 ] compared CSs therapy against standard treatment, three [ 34 – 36 ] used a placebo as the comparator, and three [ 37 – 39 ] utilized low-dose CSs. Methylprednisolone was the intervention in nine studies [ 19 , 21 , 22 , 25 , 29 , 30 , 34 – 36 ], while dexamethasone was used in twelve [ 20 , 23 , 24 , 26 – 28 , 31 – 33 , 37 – 39 ], with treatment durations ranging from 3 to 10 days.…”

Section: Resultsmentioning

confidence: 99%

“…Across 20 studies [ 19 , 23 , 28 – 32 , 34 , 35 , 37 , 39 ], involving 4898 subjects, the 28 days mortality rates were analyzed. Within the CSs-treated cohort, the mortality rate stood at 19.4%, whereas the control group exhibited a rate of 20.2%.…”

Section: Resultsmentioning

confidence: 99%

“…The subgroup analyses, based on disease severity, demonstrated that CSs application in moderate or severe COVID-19 patients had lower rates of the 28 days mortality [ 20 , 22 , 24 , 25 , 28 , 29 , 35 , 36 , 39 ] and longer 28 days ventilator-free days [ 20 , 23 ] compared with those without CSs application (Table 3 , online supplemental Figs. 1 and 2 ).…”

Section: Resultsmentioning

confidence: 99%

“…1 and 2 ). Subgroup analyses according to CSs type showed there is no statistically significant difference in 28 days mortality rates among patients treated with dexamethasone [ 23 , 24 , 28 , 32 , 33 , 37 , 39 ], methylprednisolone [ 19 , 29 , 30 , 35 , 36 ], or a combination therapy of these two CSs [ 21 , 22 , 25 ] (Table 3 , online supplemental Fig. 3 ).…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of glucocorticoids in the treatment of COVID-19: a systematic review and meta-analysis of RCTs

Ye,

Li,

Luo

et al. 2024

Clin Exp Med

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In the realm of acute respiratory infections, coronavirus disease-19 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), poses a global public health challenge. The application of corticosteroids (CSs) in COVID-19 remains a contentious topic among researchers. Accordingly, our team performed a comprehensive meta-analysis of randomized controlled trials (RCTs) to meticulously evaluate the safety and efficacy of CSs in hospitalized COVID-19 patients. To explore efficacy of CSs in the treatment of COVID-19 patients, we meticulously screened RCTs across key databases, including PubMed, Web of Science, Embase, Cochrane Library, ClinicalTrials.gov, as well as China's CNKI and Wanfang Data. We focused on assessing the 28 days mortality rates. We evaluated the data heterogeneity using the Chi-square test and I2 values, setting significance at 0.1 and 50%. Data from 21 RCTs involving 5721 participants were analyzed. The analysis did not demonstrate a significant association between CSs intervention and the 28 days mortality risk in hospitalized COVID-19 patients (relative risk [RR] = 0.93; 95% confidence interval [95% CI]: 0.84–1.03; P = 0.15). However, subgroup analysis revealed a significant reduction in 28 days mortality among patients with moderate-to-severe COVID-19 (RR at 0.85; 95% CI: 0.76–0.95; P = 0.004). Specifically, short-term CS administration (≤ 3 days) was associated with a substantial improvement in clinical outcomes (RR = 0.24; 95% CI: 0.09–0.63; P = 0.004), as was longer-term use (≥ 8 days) (RR = 0.88; 95% CI: 0.77–0.99; P = 0.04). Additionally, in patients with moderate-to-severe COVID-19, the administration of dexamethasone increased the number of 28 days ventilator-free days (Mean Difference = 1.92; 95% CI: 0.44–3.40; P = 0.01). Methylprednisolone also demonstrated significant benefits in improving clinical outcomes (RR = 0.24; 95% CI: 0.09–0.63; P = 0.004). Our meta-analysis demonstrated that although there is no significant difference in 28 days mortality rates among hospitalized COVID-19 patients, the use of CSs may be beneficial in improving clinical outcomes in moderate or severe COVID-19 patients. There was no significant increase in the occurrence of adverse events associated with the use of CSs. Our meta-analysis provides evidence that while CSs may not be suitable for all COVID-19 patients, they could be effective and safe in severely ill COVID-19 patients. Consequently, it is recommended to administer CSs for personalized treatments in COVID-19 cases to improve the clinical outcomes while minimizing adverse events.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

See 2 more Smart Citations

Efficacy and safety of glucocorticoids in the treatment of COVID-19: a systematic review and meta-analysis of RCTs

Ye,

Li,

Luo

et al. 2024

Clin Exp Med

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“…We identified twelve relevant randomised trials with results available that assessed different doses of corticosteroids in hospitalised COVID-19 patients, at least some of whom were receiving simple oxygen therapy at randomisation: six assessed higher dose dexamethasone (12-24 mg per day) and six assessed methylprednisolone (60-1000 mg per day), all compared to lower dose dexamethasone (6-8 mg per day). [27][28][29][30][31][32][33][34][35][36][37][38] Four of the trials included only a non-critically ill population and the remainder included a mixed illness severity population. 28,31,37,38 Eleven of the trials have been fully published of which five were considered to have low risk of bias for the 28-day mortality outcome and six having some concerns (including lack of information about randomisation process, lack of information about prespecified analyses, crossover between randomised groups and post-randomisation exclusion of patients in the analysis population) (appendix p31).…”

Section: Discussionmentioning

confidence: 99%

Higher dose corticosteroids in hospitalised COVID-19 patients with hypoxia but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial

Horby¹,

Emberson²,

Basnyat³

et al. 2022

Preprint

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Background: Low-dose corticosteroids have been shown to reduce mortality for hypoxic COVID-19 patients requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation or extra-corporeal membrane oxygenation). We evaluated the use of a higher dose of corticosteroids in this patient group. Methods: This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing multiple possible treatments in patients hospitalised for COVID-19. Eligible and consenting adult patients with clinical evidence of hypoxia (i.e. receiving oxygen or with oxygen saturation <92% on room air) were randomly allocated (1:1) to either usual care with higher dose corticosteroids (dexamethasone 20 mg once daily for 5 days followed by 10 mg once daily for 5 days or until discharge if sooner) or usual standard of care alone (which includes dexamethasone 6 mg once daily for 10 days or until discharge if sooner). The primary outcome was 28-day mortality. On 11 May 2022, the independent Data Monitoring Committee recommended stopping recruitment of patients receiving no oxygen or simple oxygen only to this comparison due to safety concerns. We report the results for these participants only. Recruitment of patients receiving ventilatory support continues. The RECOVERY trial is registered with ISRCTN (50189673) and clinicaltrials.gov (NCT04381936). Findings: Between 25 May 2021 and 12 May 2022, 1272 COVID-19 patients with hypoxia and receiving no oxygen (1%) or simple oxygen only (99%) were randomly allocated to receive usual care plus higher dose corticosteroids versus usual care alone (of whom 87% received low dose corticosteroids during the follow-up period). Of those randomised, 745 (59%) were in Asia, 512 (40%) in the UK and 15 (1%) in Africa. 248 (19%) had diabetes mellitus. Overall, 121 (18%) of 659 patients allocated to higher dose corticosteroids versus 75 (12%) of 613 patients allocated to usual care died within 28 days (rate ratio [RR] 1.56; 95% CI 1.18-2.06; p=0.0020). There was also an excess of pneumonia reported to be due to non-COVID infection (10% vs. 6%; absolute difference 3.7%; 95% CI 0.7-6.6) and an increase in hyperglycaemia requiring increased insulin dose (22% vs. 14%; absolute difference 7.4%; 95% CI 3.2-11.5). Interpretation: In patients hospitalised for COVID-19 with clinical hypoxia but requiring either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared to usual care, which included low dose corticosteroids. The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation or extra-corporeal membrane oxygenation.

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Systemic corticosteroids for the treatment of COVID-19: Equity-related analyses and update on evidence

Wagner

Griesel

Mikołajewska

et al. 2022

Cochrane Database of Systematic Reviews

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High-Dose vs Low-Dose Dexamethasone in Patients With Covid-19 in a Tertiary Hospital in Western Honduras

Cited by 4 publications

References 0 publications

Efficacy and safety of glucocorticoids in the treatment of COVID-19: a systematic review and meta-analysis of RCTs

Efficacy and safety of glucocorticoids in the treatment of COVID-19: a systematic review and meta-analysis of RCTs

Higher dose corticosteroids in hospitalised COVID-19 patients with hypoxia but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial

Systemic corticosteroids for the treatment of COVID-19: Equity-related analyses and update on evidence

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