An analysis of the randomized RECOVERY study revealed that, compared to standard therapy that includes low-dose corticosteroids, higher-dose corticosteroids increased the risk of death in patients with COVID-19 and hypoxia who were either getting no oxygen or just basic oxygen.

In their latest study, Landray and colleagues included 1,272 patients hospitalized with COVID and hypoxia and needed either no oxygen (1%) or simple oxygen (99%) between May 2021 and May 2022. In total, 659 patients were randomly assigned to receive dexamethasone 20 mg once daily for 5 days, followed by 10 mg once daily for 5 days, or until discharge if earlier. The remaining 613 patients were assigned to receive usual care, which included dexamethasone 6 mg once daily for 10 days or until discharge if earlier.

It was observed that 18% of those randomly allocated to higher-dose dexamethasone died within 28 days compared to 12% of those given conventional treatment. In addition, another crucial secondary outcome was that more patients in the higher-dose group required invasive mechanical breathing or died in comparison to the group receiving conventional treatment.

The researchers also found that larger doses of dexamethasone were linked to higher rates of hyperglycemia necessitating higher insulin doses (22% vs. 14%, respectively) and pneumonia caused by non-COVID infections (10% vs. 6%, respectively).

The RECOVERY experiment is still underway, and the researchers are looking into the advantages of using higher doses of corticosteroids in COVID patients with more serious illnesses who need invasive mechanical ventilation. 

(Source: https://www.medpagetoday.com/infectiousdisease/covid19/102377)