Administration of higher dose steroids in hypoxic hospitalized Covid-19 patients requiring simple oxygen therapy is associated with 60% higher risk of mortality compared with usual care (which included low dose steroids), according to results of a study conducted by the Randomised Evaluation of COVID-19 Therapy (RECOVERY) Collaborative Group published April 12, 2023 in The Lancet.¹

In this study, 659 patients hospitalized for Covid-19 hypoxia between May 25, 2021 and May 13, 2022 were randomized usual care + higher dose steroids (dexamethasone 20 mg once daily x 5 days followed by 10 mg once daily x 5 days or till the patient was discharged if occurred earlier), while 613 patients received usual care alone; of these 530 received low-dose steroids (dexamethasone 6 mg once daily x 10 days or until discharge if sooner). Sixty percent of the participants were men and almost 20% of the study group had diabetes. Majority of the study subjects were from Asia (59%) followed by the UK (40%) and Africa (1%). Through this, the researchers aimed to examine the effect of a higher dose of steroids on mortality at 28 days. Out of the 1272 patients randomized, 1264 received simple oxygen, while the remaining eight patients who did not receive any oxygen.

Nineteen percent (123/659) patients on higher dose of steroids died within 28 days compared to 12% (75/213) patients receiving usual care with rate ratio of 1.59 indicating a 60% increased risk of mortality for the higher dose steroid group. The incidence of non-Covid pneumonia was greater in the high steroid dose group; 10% vs 6%, respectively (absolute difference 3.7%).  Also, more patients (22%) patients in the higher dose group had hyperglycemia necessitating increase in insulin dose compared to 14% in the usual care group (absolute difference 7.4%). Adverse events that occurred were resolved.

This study shows that use of higher dose steroids in Covid inpatients with hypoxia who needed simple oxygen only or no oxygen was linked to significant increase in the risk of death. Notably this study stopped enrolling participants after May 13, 2022 because of safety concerns. The RECOVERY Collaborative Group is engaged in analysing the effect of high dose steroids in subgroup of hospitalized patients requiring non-invasive or invasive ventilation or extracorporeal membrane oxygenation.

Reference

1. RECOVERY Collaborative Group. Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet. 2023 Apr 12;S0140-6736(23)00510-X. doi: 10.1016/S0140-6736(23)00510-X.