Dexamethasone in hospitalised COVID-19 patients not on intensive respiratory support
et al., European Respiratory Journal, doi:10.1183/13993003.02532-2021, Nov 2021
IPTW retrospective 19,973 hospitalized COVID-19 patients showing increased 90-day mortality with dexamethasone in patients not on oxygen and no mortality benefit in patients on low-flow nasal cannula. Authors found consistent results across multiple sensitivity analyses. Authors suggest that widespread adoption of dexamethasone for less severely ill COVID-19 patients may cause unintended harm, hypothesizing that early corticosteroid use may impair viral clearance and immune responses important for infection resolution.
Standard of Care (SOC) for COVID-19 in the study country,
the USA, is very poor with very low average efficacy for approved treatments1.
Only expensive, high-profit treatments were approved for early treatment. Low-cost treatments were excluded, reducing the probability of early treatment due to access and cost barriers, and eliminating complementary and synergistic benefits seen with many low-cost treatments.
|
risk of death, 59.0% higher, HR 1.59, p < 0.001, treatment 7,507, control 7,443, all patients, propensity score weighting, Cox proportional hazards.
|
|
risk of death, 76.0% higher, HR 1.76, p < 0.001, treatment 3,124, control 6,006, no oxygen, propensity score weighting, Cox proportional hazards.
|
|
risk of death, 8.0% higher, HR 1.08, p = 0.52, treatment 4,383, control 1,437, nasal cannula, propensity score weighting, Cox proportional hazards.
|
| Effect extraction follows pre-specified rules prioritizing more serious outcomes. Submit updates |
Crothers et al., 25 Nov 2021, retrospective, USA, peer-reviewed, median age 71.0, 15 authors, study period 7 June, 2020 - 31 May, 2021.
Contact: crothk@uw.edu, permissions@ersnet.org.
Dexamethasone in hospitalised COVID-19 patients not on intensive respiratory support
European Respiratory Journal, doi:10.1183/13993003.02532-2021
Although commonly used, dexamethasone within 48 h of admission was associated with increased 90-day mortality in patients hospitalised with COVID-19 not on oxygen and with no mortality benefit in patients on low-flow nasal cannula https://bit.ly/3l2aqjb
EUROPEAN RESPIRATORY JOURNAL ORIGINAL RESEARCH ARTICLE | K. CROTHERS ET AL. on February 8, 2026 by guest. Please see licensing information on first page for reuse rights. https://publications.ersnet.org
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"abstract": "<jats:sec>\n <jats:title>Background</jats:title>\n <jats:p>Dexamethasone decreases mortality in coronavirus disease 2019 (COVID-19) patients on intensive respiratory support (IRS) but is of uncertain benefit if less severely ill. We determined whether early (within 48 h) dexamethasone was associated with mortality in patients hospitalised with COVID-19 not on IRS.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Methods</jats:title>\n <jats:p>We included patients admitted to US Veterans Affairs hospitals between 7 June 2020 and 31 May 2021 within 14 days after a positive test for severe acute respiratory syndrome coronavirus 2. Exclusions included recent prior corticosteroids and IRS within 48 h. We used inverse probability of treatment weighting (IPTW) to balance exposed and unexposed groups, and Cox proportional hazards models to determine 90-day all-cause mortality.</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Results</jats:title>\n <jats:p>Of 19 973 total patients (95% men, median age 71 years, 27% black), 15 404 (77%) were without IRS within 48 h. Of these, 3514 out of 9450 (34%) patients on no oxygen received dexamethasone and 1042 (11%) died; 4472 out of 5954 (75%) patients on low-flow nasal cannula (NC) only received dexamethasone and 857 (14%) died. In IPTW stratified models, patients on no oxygen who received dexamethasone experienced 76% increased risk for 90-day mortality (hazard ratio (HR) 1.76, 95% CI 1.47–2.12); there was no association with mortality among patients on NC only (HR 1.08, 95% CI 0.86–1.36).</jats:p>\n </jats:sec>\n <jats:sec>\n <jats:title>Conclusions</jats:title>\n <jats:p>In patients hospitalised with COVID-19, early initiation of dexamethasone was common and was associated with no mortality benefit among those on no oxygen or NC only in the first 48 h; instead, we found evidence of potential harm. These real-world findings do not support the use of early dexamethasone in hospitalised COVID-19 patients without IRS.</jats:p>\n </jats:sec>",
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Late treatment
is less effective
is less effective
