Summary of COVID-19 dexamethasone studies
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RCT 6,425 hospitalized COVID-19 patients showing lower 28-day mortality with dexamethasone treatment. The benefit was most pronounced in patients who had symptoms for more than 7 days at randomization, suggesting dexamethasone is most effective when the disease is dominated by inflammatory processes rather than viral replication.
Feb 2021, New England J. Medicine, http://www.nejm.org/doi/10.1056/NEJMoa2021436, https://c19p.org/horby5
Retrospective 576 hospitalized COVID-19 patients showing lower mortality with dexamethasone treatment.
Nov 2024, BMC Infectious Diseases, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-10216-3, https://c19p.org/zhao17
RCT 299 patients with moderate or severe COVID-19-related ARDS showing increased ventilator-free days with dexamethasone treatment. There was no significant difference in 28-day mortality (56.3% vs 61.5%), ICU-free days, or mechanical ventilation duration.
Oct 2020, JAMA, https://jamanetwork.com/journals/jama/fullarticle/2770277, https://c19p.org/tomazini
PSM retrospective 80,699 hospitalized COVID-19 patients showing reduced mortality or discharge to hospice with dexamethasone in patients requiring supplemental oxygen or mechanical ventilation/ECMO, but no significant difference in patients not requiring supplemental oxygen or on NIPPV.
Apr 2023, JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803926, https://c19p.org/mourad2
Retrospective 672 COVID-19 patients in Zimbabwe, showing higher mortality with dexamethasone treatment.
Mar 2023, Pan African Medical J., https://www.panafrican-med-journal.com/content/article/44/142/full, https://c19p.org/madamombedx
Retrospective propensity score matched study of 529 hospitalized diabetic COVID-19 patients showing no significant difference in mortality or clinical improvement with dexamethasone treatment.
Oct 2024, The J. Clinical Endocrinology & Metabolism, https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgae734/7825467, https://c19p.org/bhat2
Retrospective 410 hospitalized COVID-19 patients in the Democratic Republic of Congo showing significantly lower mortality with vitamin C treatment.
May 2025, Infection and Drug Resistance, https://www.dovepress.com/clinical-characteristics-and-mortality-trends-among-covid-19-patients--peer-reviewed-fulltext-article-IDR, https://c19p.org/bepoukadex
Retrospective 2,196 COVID-19 patients in Taiwan (49% mild cases, 44% moderate, 7% severe) showing significantly higher mortality with dexamethasone.
Aug 2024, BMC Infectious Diseases, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09654-w, https://c19p.org/yen3
Retrospective 30 hospitalized patients with sickle cell disease (SCD) showing increased risk of venous thromboembolism (VTE) with dexamethasone treatment for COVID-19. There were also trends towards increased ICU admission and longer hospital stays with dexamethasone, without statistical significance.
Nov 2024, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0313289, https://c19p.org/garneau
RCT 126 hospitalized COVID-19 pneumonia patients not requiring oxygen at admission, showing no significant difference in outcomes with dexamethasone treatment.
Jul 2024, Frontiers in Medicine, https://www.frontiersin.org/articles/10.3389/fmed.2024.1385833/full, https://c19p.org/francomorenodex
Pilot RCT of 7 outpatients with non-severe COVID-19 suggesting potential harmful effects of dexamethasone treatment. Time to recovery was significantly longer in the dexamethasone group compared to controls (p=0.03). Authors note that systemic corticosteroids, while beneficial for hospitalized COVID-19 patients requiring oxygen, may be harmful in non-severe cases by potentially inhibiting normal immune response when administered too early.
Apr 2022, ERJ Open Research, https://publications.ersnet.org/lookup/doi/10.1183/23120541.00129-2022, https://c19p.org/kocks
1. Horby et al., Dexamethasone in Hospitalized Patients with Covid-19
6,425 patient dexamethasone late treatment RCT: 17% lower mortality (p=0.0007), 21% lower ventilation (p=0.03), and 9% higher hospital discharge (p=0.003).RCT 6,425 hospitalized COVID-19 patients showing lower 28-day mortality with dexamethasone treatment. The benefit was most pronounced in patients who had symptoms for more than 7 days at randomization, suggesting dexamethasone is most effective when the disease is dominated by inflammatory processes rather than viral replication.
Feb 2021, New England J. Medicine, http://www.nejm.org/doi/10.1056/NEJMoa2021436, https://c19p.org/horby5
2. Zhao et al., The impact of dexamethasone on short- and long-term mortality in hospitalized COVID-19 patients: a retrospective study
576 patient dexamethasone late treatment PSM study: 34% lower mortality (p=0.01).Retrospective 576 hospitalized COVID-19 patients showing lower mortality with dexamethasone treatment.
Nov 2024, BMC Infectious Diseases, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-10216-3, https://c19p.org/zhao17
3. Tomazini et al., Effect of Dexamethasone on Days Alive and Ventilator-Free in Patients With Moderate or Severe Acute Respiratory Distress Syndrome and COVID-19
299 patient dexamethasone late treatment RCT: 3% lower mortality (p=0.85) and 34% improvement (p=0.07).RCT 299 patients with moderate or severe COVID-19-related ARDS showing increased ventilator-free days with dexamethasone treatment. There was no significant difference in 28-day mortality (56.3% vs 61.5%), ICU-free days, or mechanical ventilation duration.
Oct 2020, JAMA, https://jamanetwork.com/journals/jama/fullarticle/2770277, https://c19p.org/tomazini
4. Mourad et al., Dexamethasone for Inpatients With COVID-19 in a National Cohort
56,368 patient dexamethasone late treatment study: 10% lower mortality (p=0.0002).PSM retrospective 80,699 hospitalized COVID-19 patients showing reduced mortality or discharge to hospice with dexamethasone in patients requiring supplemental oxygen or mechanical ventilation/ECMO, but no significant difference in patients not requiring supplemental oxygen or on NIPPV.
Apr 2023, JAMA Network Open, https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2803926, https://c19p.org/mourad2
5. Madamombe et al., Factors associated with COVID-19 fatality among patients admitted in Mashonaland West Province, Zimbabwe 2020-2022: a secondary data analysis
672 patient dexamethasone early treatment study: 130% higher mortality (p<0.0001).Retrospective 672 COVID-19 patients in Zimbabwe, showing higher mortality with dexamethasone treatment.
Mar 2023, Pan African Medical J., https://www.panafrican-med-journal.com/content/article/44/142/full, https://c19p.org/madamombedx
6. Bhat et al., Effectiveness of Dexamethasone for COVID-19 in Hospitalized Patients With Diabetes: A Retrospective Cohort Study
1,058 patient dexamethasone late treatment PSM study: 35% higher mortality (p=0.2) and 46% worse improvement (p=0.02).Retrospective propensity score matched study of 529 hospitalized diabetic COVID-19 patients showing no significant difference in mortality or clinical improvement with dexamethasone treatment.
Oct 2024, The J. Clinical Endocrinology & Metabolism, https://academic.oup.com/jcem/advance-article/doi/10.1210/clinem/dgae734/7825467, https://c19p.org/bhat2
7. Bepouka et al., Clinical Characteristics and Mortality Trends Among COVID-19 Patients During the First Four Waves in Ngaliema Clinic, Democratic Republic of the Congo
410 patient dexamethasone late treatment study: 104% higher mortality (p=0.55).Retrospective 410 hospitalized COVID-19 patients in the Democratic Republic of Congo showing significantly lower mortality with vitamin C treatment.
May 2025, Infection and Drug Resistance, https://www.dovepress.com/clinical-characteristics-and-mortality-trends-among-covid-19-patients--peer-reviewed-fulltext-article-IDR, https://c19p.org/bepoukadex
8. Yen et al., Predictors for cause-specific and timing of deaths in patients with COVID-19: a cohort study in Taiwan
2,196 patient dexamethasone late treatment study: 103% higher mortality (p=0.0002).Retrospective 2,196 COVID-19 patients in Taiwan (49% mild cases, 44% moderate, 7% severe) showing significantly higher mortality with dexamethasone.
Aug 2024, BMC Infectious Diseases, https://bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-024-09654-w, https://c19p.org/yen3
9. Garneau et al., Clinical effects of dexamethasone among patients with sickle cell disease hospitalized with COVID-19: Outcomes from a single academic health system
30 patient dexamethasone late treatment study: 423% higher ICU admission (p=0.14) and 155% longer hospitalization (p=0.06).Retrospective 30 hospitalized patients with sickle cell disease (SCD) showing increased risk of venous thromboembolism (VTE) with dexamethasone treatment for COVID-19. There were also trends towards increased ICU admission and longer hospital stays with dexamethasone, without statistical significance.
Nov 2024, PLOS ONE, https://journals.plos.org/plosone/article?id=10.1371/journal.pone.0313289, https://c19p.org/garneau
10. Franco-Moreno et al., Effect of early administration of dexamethasone in patients with COVID-19 pneumonia without acute hypoxemic respiratory failure and risk of development of acute respiratory distress syndrome: EARLY-DEX COVID-19 trial
126 patient dexamethasone late treatment RCT: 134% higher ventilation (p=0.41), 217% higher ICU admission (p=0.46), 17% higher ARDS (p=0.81), and 3% shorter hospitalization (p=0.88).RCT 126 hospitalized COVID-19 pneumonia patients not requiring oxygen at admission, showing no significant difference in outcomes with dexamethasone treatment.
Jul 2024, Frontiers in Medicine, https://www.frontiersin.org/articles/10.3389/fmed.2024.1385833/full, https://c19p.org/francomorenodex
11. Kocks et al., A potential harmful effect of dexamethasone in non-severe COVID-19: results from the COPPER-pilot study
6 patient dexamethasone early treatment RCT: 600% worse recovery (p=0.07).Pilot RCT of 7 outpatients with non-severe COVID-19 suggesting potential harmful effects of dexamethasone treatment. Time to recovery was significantly longer in the dexamethasone group compared to controls (p=0.03). Authors note that systemic corticosteroids, while beneficial for hospitalized COVID-19 patients requiring oxygen, may be harmful in non-severe cases by potentially inhibiting normal immune response when administered too early.
Apr 2022, ERJ Open Research, https://publications.ersnet.org/lookup/doi/10.1183/23120541.00129-2022, https://c19p.org/kocks
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