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Dexamethasone in Hospitalized Patients with Covid-19
Open accessPublished version of a preprint
Abstract
BACKGROUND: Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death. METHODS: In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the final results of this assessment. RESULTS: A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.92 to 1.55). CONCLUSIONS: In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.).
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“Until the release of the RECOVERY trial,66 patients with severe COVID-19 were not routinely treated with GC agonists such as dexamethasone.”
From Cystatin C is glucocorticoid responsive, directs recruitment of Trem2+ macrophages, and predicts failure of cancer immunotherapy (2023) · cites this paper as [66]
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“In addition, dexamethasone reduces the death rate of patients with severe COVID-19 (370).”
From IL-6 in inflammation, autoimmunity and cancer (2021) · cites this paper as [370]
In the citing paper
“These studies were, however, restricted to only publications up to August and October 2020—which is not representative of the current landscape of covid-19 research and which does not include the majority of evidence being currently used to guide covid-19 care, including critical trials of the effects of corticosteroids and interleukin 6 receptor blockers.”
From Consistency of covid-19 trial preprints with published reports and impact for decision making: retrospective review (2022) · cites this paper as [2]
In the citing paper
“reports of hemophagocytosis and elevated cytokine levels — as well as beneficial effects of immunosuppressant agents — in affected patients, particularly those who are the most severely ill, suggest that cytokine storm may contribute to the pathogenesis of Covid-19.87,88”
From Cytokine storm (2020) · cites this paper as [88]
In the citing paper
“a recent randomized, controlled trial showing that dexamethasone reduces mortality among the most severe cases of Covid-19, characterized by elevated CRP levels and supplemental oxygen requirements, and potentially worsens outcomes in milder cases suggests that excessive, late-stage inflammation contributes to mortality.88”
From Cytokine storm (2020) · cites this paper as [88]
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Metadata
- Authors
- The RECOVERY Collaborative Group
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2021-02-25
- Volume
- 384
- Issue
- 8
- Pages
- 693-704
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- PMC
- PMC7383595
- OpenAlex
- W3042270788
- Cited by
- 11,477
- References
- 43
- Citations by year
- 2026: 301 · 2025: 573 · 2024: 932 · 2023: 1534 · 2022: 2623 · 2021: 3849
- FWCI
- 316.80
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- Locations
- New England Journal of Medicine (publishedVersion)
- medRxiv (acceptedVersion, cc-by)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- DiRROS repository (University of Maribor) (publishedVersion, cc-by)
- Repository@Nottingham (University of Nottingham) (publishedVersion, other-oa)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (publishedVersion)
- Explore Bristol Research (publishedVersion, cc-by)
- ePrints Soton (University of Southampton) (acceptedVersion)
- ORCA Online Research @Cardiff (Cardiff University) (acceptedVersion)
- St George's Online Research Archive (St George's University of London) (acceptedVersion)
- UEA Digital Repository (University of East Anglia) (acceptedVersion)
- ENLIGHTEN (Jurnal Bimbingan dan Konseling Islam) (acceptedVersion, cc-by-sa)
- Repository@Nottingham (University of Nottingham) (submittedVersion, cc-by)
- Spiral (Imperial College London) (submittedVersion)
- Sussex Research Online (University of Sussex) (submittedVersion)
- UCL Discovery (University College London) (submittedVersion)
- Figshare (submittedVersion)
- Edinburgh Napier Research Repository (Edinburgh Napier University) (submittedVersion)
- University of Birmingham Research Portal (University of Birmingham) (submittedVersion, other-oa)
- Research Explorer (The University of Manchester) (submittedVersion)
- Edinburgh Research Explorer (University of Edinburgh) (submittedVersion, other-oa)
- Queen Mary Research Online (Queen Mary University of London) (submittedVersion)
- St Andrews Research Repository (St Andrews Research Repository) (submittedVersion)
- Apollo (University of Cambridge) (submittedVersion)
- Apollo
- Funders
- United Kingdom Research and Innovation (MC_PC_19056)
- National Institute for Health Research (MC_PC_19056)
- Topics
- Health Sciences › Medicine › Infectious Diseases › COVID-19 Clinical Research Studies
- Health Sciences › Medicine › Pulmonary and Respiratory Medicine › Respiratory Support and Mechanisms
- Health Sciences › Medicine › Infectious Diseases › SARS-CoV-2 and COVID-19 Research
- Keywords
- dexamethasone, COVID-19 pandemic, glucocorticoids, 28-day mortality, invasive mechanical ventilation, oxygen therapy, respiratory support, lung injury, anti-inflammatory therapy, hospitalized patients, RECOVERY trial, usual care comparison, treatment effect heterogeneity
- MeSH terms
- COVID-19, COVID-19 Drug Treatment, Administration, Oral, Aged, Aged, 80 and over, Anti-Infective Agents, Dexamethasone, Drug Therapy, Combination, Female, Glucocorticoids, United Kingdom, Hospitalization, Humans, Injections, Intravenous, Length of Stay, Male, Oxygen Inhalation Therapy, Respiration, Artificial, Odds Ratio, Kaplan-Meier Estimate
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