Effect of Dexamethasone in Hospitalized Patients with COVID-19 – Preliminary Report
Open accessPreprint — published as 10.1056/nejmoa2021436 · Paper page
Abstract
Background: Coronavirus disease 2019 (COVID-19) is associated with diffuse lung damage. Corticosteroids may modulate immune-mediated lung injury and reducing progression to respiratory failure and death. Methods: The Randomised Evaluation of COVID-19 therapy (RECOVERY) trial is a randomized, controlled, open-label, adaptive, platform trial comparing a range of possible treatments with usual care in patients hospitalized with COVID-19. We report the preliminary results for the comparison of dexamethasone 6 mg given once daily for up to ten days vs. usual care alone. The primary outcome was 28-day mortality. Results: 2104 patients randomly allocated to receive dexamethasone were compared with 4321 patients concurrently allocated to usual care. Overall, 454 (21.6%) patients allocated dexamethasone and 1065 (24.6%) patients allocated usual care died within 28 days (age-adjusted rate ratio [RR] 0.83; 95% confidence interval [CI] 0.74 to 0.92; P<0.001). The proportional and absolute mortality rate reductions varied significantly depending on level of respiratory support at randomization (test for trend p<0.001): Dexamethasone reduced deaths by one-third in patients receiving invasive mechanical ventilation (29.0% vs. 40.7%, RR 0.65 [95% CI 0.51 to 0.82]; p<0.001), by one-fifth in patients receiving oxygen without invasive mechanical ventilation (21.5% vs. 25.0%, RR 0.80 [95% CI 0.70 to 0.92]; p=0.002), but did not reduce mortality in patients not receiving respiratory support at randomization (17.0% vs. 13.2%, RR 1.22 [95% CI 0.93 to 1.61]; p=0.14). Conclusions: In patients hospitalized with COVID-19, dexamethasone reduced 28-day mortality among those receiving invasive mechanical ventilation or oxygen at randomization, but not among patients not receiving respiratory support. Trial registrations: The RECOVERY trial is registered with ISRCTN (50189673) and clinicaltrials.gov ( NCT04381936 ). Funding: Medical Research Council and National Institute for Health Research (Grant ref: MC_PC_19056).
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Previous studies were restricted to only publications up to August and October 2020, which is not representative of the current landscape of covid-19 research and 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.
“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 [1]
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Cites
Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China
Huang, C., Wang, Y., Li, X., Ren, L., Zhao, J., Hu, Y., Zhang, L., Fan, G., Xu, J., Gu, X., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30183-5 · Cited by 48,884 · cited 1× · see citing works
“Inflammatory organ injury may occur in severe COVID-19, with a subset of patients having markedly elevated inflammatory markers such as C-reactive protein, ferritin, and interleukins 1 and 6.(6,15,16) Several therapeutic interventions to mitigate inflammatory organ injury have been proposed in viral pneumonia but the…”
BackgroundA novel coronavirus from patients with pneumonia in China, 2019
Zhu, N., Zhang, D., Wang, W., Li, X., Yang, B., Song, J., Zhao, X., Huang, B., Shi, W., Lu, R., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2001017 · Cited by 28,244 · see citing works
Zhou, F., Yu, T., Du, R., Fan, G., Liu, Y., Liu, Z., Xiang, J., Wang, Y., Song, B., Gu, X., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30566-3 · Cited by 27,263 · see citing works
Chen, N., Zhou, M., Dong, X., Qu, J., Gong, F., Han, Y., Qiu, Y., Wang, J., Liu, Y., Wei, Y., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30211-7 · Cited by 21,415 · see citing works
Wang, D., Hu, B., Hu, C., Zhu, F., Liu, X., Zhang, J., Wang, B., Xiang, H., Cheng, Z., Xiong, Y., et al. (2020) · JAMA · doi:10.1001/jama.2020.1585 · Cited by 20,148 · cited 2× · see citing works
“Significantly fewer patients allocated to dexamethasone met the primary outcome of 28-day mortality than in the usual care group (454 of 2104 patients [21.6”
BackgroundInfluentialRemdesivir for the Treatment of Covid-19 — Final Report
Beigel, J. H., Tomashek, K. M., Dodd, L. E., Mehta, A. K., Zingman, B. S., Kalil, A. C., Hohmann, E., Chu, H. Y., Luetkemeyer, A., Kline, S., et al. (2020) · New England Journal of Medicine · doi:10.1056/nejmoa2007764 · Cited by 7,267 · see citing works
Virological assessment of hospitalized patients with COVID-2019
Wölfel, R., Corman, V. M., Guggemos, W., Seilmaier, M., Zange, S., Müller, M. A., Niemeyer, D., Jones, T. C., Vollmar, P., Rothe, C., et al. (2020) · Nature · doi:10.1038/s41586-020-2196-x · Cited by 6,661 · cited 1× · see citing works
“29,32,33 35-38 The greater mortality benefit of dexamethasone in patients with COVID-19 who required respiratory support, and among those recruited after the first week of their illness, suggests that at this stage the disease is dominated by immunopathology, with active virus replication playing a…”
BackgroundRuan, Q., Yang, K., Wang, W., Jiang, L., & Song, J. (2020) · Intensive Care Medicine · doi:10.1007/s00134-020-05991-x · Cited by 4,898 · cited 2× · see citing works
“14 Inflammatory organ injury may occur in severe COVID-19, with a subset of patients having markedly elevated inflammatory markers such as C-reactive protein, ferritin, and interleukins 1 and 6.”
BackgroundTemporal dynamics in viral shedding and transmissibility of COVID-19
He, X., Lau, E. H. Y., Wu, P., Deng, X., Wang, J., Hao, X., Lau, Y. C., Wong, J. Y., Guan, Y., Tan, X., et al. (2020) · Nature Medicine · doi:10.1038/s41591-020-0869-5 · Cited by 4,242 · see citing works
Estimates of the severity of coronavirus disease 2019: a model-based analysis
Verity, R., Okell, L. C., Dorigatti, I., Winskill, P., Whittaker, C., Imai, N., Cuomo-Dannenburg, G., Thompson, H., Walker, P. G. T., Fu, H., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30243-7 · Cited by 3,660 · see citing works
Docherty, A. B., Harrison, E. M., Green, C. A., Hardwick, H. E., Pius, R., Norman, L., Holden, K. A., Read, J. M., Dondelinger, F., Carson, G., et al. (2020) · BMJ · doi:10.1136/bmj.m1985 · Cited by 3,481 · see citing works
Self-citationTo, K. K., Tsang, O. T.-Y., Leung, W.-S., Tam, A. R., Wu, T.-C., Lung, D. C., Yip, C. C., Cai, J., Chan, J. M., Chik, T. S., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30196-1 · Cited by 3,045 · cited 1× · see citing works
“29,32,33 35-38 The greater mortality benefit of dexamethasone in patients with COVID-19 who required respiratory support, and among those recruited after the first week of their illness, suggests that at this stage the disease is dominated by immunopathology, with active virus replication playing a…”
BackgroundPrevalence of Asymptomatic SARS-CoV-2 Infection
Oran, D. P., & Topol, E. J. (2020) · Annals of Internal Medicine · doi:10.7326/m20-3012 · Cited by 2,280 · see citing works
Xu, X., Wu, X., Jiang, X., Xu, K., Ying, L.-J., Ma, C., Li, S., Wang, H., Zhang, S., Gao, H., et al. (2020) · BMJ · doi:10.1136/bmj.m606 · Cited by 2,047 · cited 1× · see citing works
“21,22 Here we report the results of a randomized controlled trial of dexamethasone in patients hospitalized with COVID-19.”
BackgroundClinical evidence does not support corticosteroid treatment for 2019-nCoV lung injury
Russell, C. D., Millar, J. E., & Baillie, J. K. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30317-2 · Cited by 2,007 · cited 1× · see citing works
“Several therapeutic interventions to mitigate inflammatory organ injury have been proposed in viral pneumonia but the value of corticosteroids has been widely debated.(17,18)”
BackgroundSelf-citationCytokine release syndrome in severe COVID-19
Moore, J. B., & June, C. H. (2020) · Science · doi:10.1126/science.abb8925 · Cited by 1,912 · cited 1× · see citing works
“Inflammatory organ injury may occur in severe COVID-19, with a subset of patients having markedly elevated inflammatory markers such as C-reactive protein, ferritin, and interleukins 1 and 6.(6,15,16) Several therapeutic interventions to mitigate inflammatory organ injury have been proposed in viral pneumonia but the…”
BackgroundFatal outcome of human influenza A (H5N1) is associated with high viral load and hypercytokinemia.
de Jong, M. D., Simmons, C. P., Thanh, T. T., Hien, V. M., Smith, G. J. D., Chau, T. N. B., Hoang, D. M., Van Vinh Chau, N., Khanh, T. H., Dong, V. C., et al. (2006) · Nature Medicine · doi:10.1038/nm1477 · Cited by 1,858 · see citing works
Remdesivir for the Treatment of Covid-19 — Preliminary Report
Gillenwater, S., Rahaghi, F., & Hadeh, A. (2020) · New England Journal of Medicine · doi:10.1056/nejmc2022236 · Cited by 1,422 · see citing works
Carsana, L., Sonzogni, A., Nasr, A., Rossi, R. S., Pellegrinelli, A., Zerbi, P., Rech, R., Colombo, R., Antinori, S., Corbellino, M., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30434-5 · Cited by 1,402 · cited 1× · see citing works
“The pathophysiology of severe COVID-19 is dominated by an acute pneumonic process with extensive radiological opacity and, on autopsy, diffuse alveolar damage, inflammatory infiltrates and microvascular thromobosis.(9,10) The host immune response is thought to play a key role in the pathophysiology of organ failure in…”
BackgroundPlasma inflammatory cytokines and chemokines in severe acute respiratory syndrome
Wong, C. K., LAM, C. W. K., Wu, A. K. L., Ip, W., Lee, N. L. S., Chan, I., Lit, L. C. W., Hui, D. S. C., Chan, M. H. M., CHUNG, S. S. C., et al. (2004) · Clinical & Experimental Immunology · doi:10.1111/j.1365-2249.2004.02415.x · Cited by 1,270 · see citing works
SARS: systematic review of treatment effects
Stockman, L. J., Bellamy, R., & Garner, P. (2006) · PLoS Medicine · doi:10.1371/journal.pmed.0030343 · Cited by 1,217 · cited 1× · see citing works
“28-31 In addition, the evidence base has suffered from heterogeneity in corticosteroid doses, medical conditions, and disease severity studied.”
BackgroundCorticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome
Arabi, Y. M., Mandourah, Y., Al-Hameed, F. M., Sindi, A., Almekhlafi, G. A., Hussein, M. A., Jose, J., Pinto, R. L., Al‐Omari, A., Kharaba, A. M., et al. (2017) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.201706-1172oc · Cited by 1,122 · see citing works
Why do we need some large, simple randomized trials?
Yusuf, S., Collins, R., & Peto, R. (1984) · Statistics in Medicine · doi:10.1002/sim.4780030421 · Cited by 700 · cited 2× · see citing works
“23-25 It has progressed at unprecedented speed, as is essential for studies during epidemics.”
BackgroundLee, N. L. S., Chan, K. C. A., Hui, D. S. C., Ng, E. K. O., Wu, A. K., Chiu, R. W. K., Wong, V. W., Chan, P. K. S., Wong, K. T., Wong, E., et al. (2004) · Journal of Clinical Virology · doi:10.1016/j.jcv.2004.07.006 · Cited by 636 · cited 1× · see citing works
“Slower clearance of viral RNA has been observed in patients with SARS, MERS and influenza treated with systemic corticosteroids but the clinical significance of this is unknown.(29,32,33) Unlike SARS, where viral replication peaks in the second week of illness,(34) peak viral shedding in COVID-19 appears to be higher…”
BackgroundOn the use of corticosteroids for 2019-nCoV pneumonia
Shang, L., Zhao, J., Hu, Y., Du, R., & Cao, B. (2020) · The Lancet · doi:10.1016/s0140-6736(20)30361-5 · Cited by 604 · cited 1× · see citing works
“Several therapeutic interventions to mitigate inflammatory organ injury have been proposed in viral pneumonia but the value of corticosteroids has been widely debated.(17,18)”
BackgroundPathological evidence of pulmonary thrombotic phenomena in severe COVID‐19
Dolhnikoff, M., Duarte‐Neto, A. N., Monteiro, R. A. D. A., da Silva, L. F. F., Oliveira, E. P., Saldiva, P. H. N., Mauad, T., & Negri, E. M. (2020) · Journal of Thrombosis and Haemostasis · doi:10.1111/jth.14844 · Cited by 592 · see citing works
Viral Loads and Duration of Viral Shedding in Adult Patients Hospitalized with Influenza
Lee, N. L. S., Chan, P. K. S., Hui, D. S. C., Rainer, T. H., Wong, E., Choi, K., Lui, G. C.-Y., Wong, B. C. K., Wong, R. Y. K., Lam, W., et al. (2009) · The Journal of Infectious Diseases · doi:10.1086/600383 · Cited by 522 · cited 1× · see citing works
“29,32,33 35-38 The greater mortality benefit of dexamethasone in patients with COVID-19 who required respiratory support, and among those recruited after the first week of their illness, suggests that at this stage the disease is dominated by immunopathology, with active virus replication playing a…”
BackgroundCao, J., Tu, W., Cheng, W., Yu, L., Liu, Y., Hu, X., & Liu, Q. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa243 · Cited by 492 · see citing works
The Magic of Randomization versus the Myth of Real-World Evidence
Collins, R., Bowman, L. J., Landray, M., & Peto, R. (2020) · New England Journal of Medicine · doi:10.1056/nejmsb1901642 · Cited by 481 · see citing works
Self-citationRuan, Q., YANG, K. Y., Wang, W., Jiang, L., & Song, J. (2020) · Intensive Care Medicine · doi:10.1007/s00134-020-06028-z · Cited by 421 · see citing works
Cameron, M. J., Ran, L., Xu, L., Danesh, A., Bermejo-Martin, J. F., Cameron, C. M., Muller, M. P., Gold, W. L., Richardson, S. E., Poutanen, S. M., et al. (2007) · Journal of Virology · doi:10.1128/jvi.00527-07 · Cited by 386 · see citing works
Viral shedding patterns of coronavirus in patients with probable severe acute respiratory syndrome
Cheng, P. K. C., Wong, D. A., Tong, L. K. L., Ip, S.-M., Lo, A. C. T., Lau, C. S., Yeung, E. Y. H., & Lim, W. W. L. (2004) · The Lancet · doi:10.1016/s0140-6736(04)16255-7 · Cited by 332 · see citing works
Self-citationCorticosteroid Therapy for Patients Hospitalized With Community-Acquired Pneumonia
Siemieniuk, R. A. C., Meade, M. O., Alonso‐Coello, P., Briel, M., Evaniew, N., Prasad, M., Alexander, P. E., Fei, Y., Vandvik, P. O., Loeb, M. B., et al. (2015) · Annals of Internal Medicine · doi:10.7326/m15-0715 · Cited by 323 · see citing works
Viral dynamics in asymptomatic patients with COVID-19
Zhou, R., Li, F., Chen, F., Liu, H., Zheng, J., Lei, C., & Wu, X. (2020) · International Journal of Infectious Diseases · doi:10.1016/j.ijid.2020.05.030 · Cited by 229 · see citing works
Lansbury, L. E., Rodrigo, C., Leonardi-Bee, J., Nguyen-Van-Tam, J., & Shen Lim, W. (2020) · Critical Care Medicine · doi:10.1097/ccm.0000000000004093 · Cited by 207 · see citing works
Self-citationPulmonary post-mortem findings in a large series of COVID-19 cases from Northern ItalyPreprint
Carsana, L., Sonzogni, A., Nasr, A., et al. (2020) · medRxiv · doi:10.1101/2020.04.19.20054262 · Cited by 161 · see citing works
Dagens, A., Sigfrid, L., Cai, E., Lipworth, S., Cheng, V., Harris, E., Bannister, P., Rigby, I., & Horby, P. (2020) · BMJ · doi:10.1136/bmj.m1936 · Cited by 156 · cited 1× · see citing works
“Prior to RECOVERY, many COVID-19 treatment guidelines stated that corticosteroids were either ‘contraindicated’ or ‘not recommended’ 19 although in China, corticosteroids are recommended for severe cases.”
BackgroundSelf-citation[Expert consensus on the use of corticosteroid in patients with 2019-nCoV pneumonia].
Zhao, J. P., Hu, Y., Du, R. H., Chen, Z. S., Jin, Y.-H., Zhou, M., Zhang, J., Qu, J. M., & Cao, B. (2020) · PubMed · doi:10.3760/cma.j.issn.1001-0939.2020.0007 · Cited by 149 · cited 1× · see citing works
“Prior to RECOVERY, many COVID-19 treatment guidelines stated that corticosteroids were either ‘contraindicated’ or ‘not recommended’(19) although in China, corticosteroids are recommended for severe cases.(20) Practice has varied widely across the world: in some series, as many as 50% of cases were .”
BackgroundMaurer, J. (2016) · Yearbook of Pulmonary Disease · doi:10.1016/j.ypdi.2015.12.005 · Cited by 68 · cited 1×
“28-31 In addition, the evidence base has suffered from heterogeneity in corticosteroid doses, medical conditions, and disease severity studied.”
Influenza — Time to Target the Host?
Baillie, J. K., & Digard, P. (2013) · New England Journal of Medicine · doi:10.1056/nejmcibr1304414 · Cited by 55 · cited 1× · see citing works
“The host immune response is thought to play a key role in the pathophysiology of organ failure in other severe viral pneumonias such as highly pathogenic avian influenza,(11) severe acute respiratory syndrome (SARS),(12,13) and pandemic and seasonal influenza.(14) Inflammatory organ injury may occur in severe COVID-19…”
BackgroundSelf-citationModernising epidemic science: enabling patient-centred research during epidemics
Rojek, A. M., & Horby, P. (2016) · BMC Medicine · doi:10.1186/s12916-016-0760-x · Cited by 43 · cited 1× · see citing works
“It has progressed at unprecedented speed, as is essential for studies during epidemics.(26) These preliminary results for dexamethasone were announced on 16 June 2020, just 98 days after the protocol was first drafted, and were adopted into UK practice later the same day.”
BackgroundSelf-citationLiaudet, L., & Szabó, C. (2020) · Critical Care · doi:10.1186/s13054-020-03055-6 · Cited by 41 · cited 1× · see citing works
“It is also possible there is an effect via mineralocorticoid receptor binding in the context of SARS-CoV-2 induced dysregulation of the renin-angiotensin system.(39) This would caution against extrapolating the effect of dexamethasone in patients with COVID-19 to patients with other viral respiratory diseases that hav…”
BackgroundPulmonary Post-Mortem Findings in a Large Series of COVID-19 Cases from Northern ItalyPreprint
Carsana, L., Sonzogni, A., Nasr, A., Rossi, R. S., Pellegrinelli, A., Zerbi, P., Rech, R., Colombo, R., Antinori, S., Corbellino, M., et al. (2020) · SSRN Electronic Journal · doi:10.2139/ssrn.3572890 · Cited by 39 · see citing works
Flagged first, then by citations
Research works printed but not linked: 1
- Randomised trial of intravenous streptokinase, oral aspirin, both, or neither among 17,187 cases of suspected acute myocardial infarction: ISIS-2. ISIS-2 (Second International Study of Infarct Survival) Collaborative Group. Lancet 1988; 2(8607): 349-60.
Cited by
Sorted by citations
Wiersinga, W. J., Rhodes, A., Cheng, A. C., Peacock, S. J., & Prescott, H. C. (2020) · JAMA · doi:10.1001/jama.2020.12839 · Cited by 4,609 · see citing works
The WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne, J. A. C., Murthy, S., Diaz, J. V., Slutsky, A. S., Villar, J., Angus, D. C., Annane, D., Azevedo, L. C. P., Berwanger, O., et al. (2020) · JAMA · doi:10.1001/jama.2020.17023 · Cited by 2,257 · see citing works
Self-citationREGN-COV2, a Neutralizing Antibody Cocktail, in Outpatients with Covid-19
Weinreich, D. M., Sivapalasingam, S., Norton, T., Ali, S., Gao, H., Bhore, R., Musser, B. J., Soo, Y., Rofail, D., Im, J., et al. (2021) · New England Journal of Medicine · doi:10.1056/nejmoa2035002 · Cited by 1,642 · see citing works
Berlin, D., Gulick, R. M., & Martínez, F. J. (2020) · New England Journal of Medicine · doi:10.1056/nejmcp2009575 · Cited by 1,426 · see citing works
Tomazini, B. M., Maia, I. S., Cavalcanti, A. B., Berwanger, O., Rosa, R. G., Veiga, V. C., Avezum, A., Lopes, R. D., Bueno, F. R., Silva, M. V. A. O., et al. (2020) · JAMA · doi:10.1001/jama.2020.17021 · Cited by 1,241 · see citing works
Fajgenbaum, D. C., & June, C. H. (2020) · New England Journal of Medicine · doi:10.1056/nejmra2026131 · Cited by 3,196 · see citing works
Popkin, B. M., Du, S., Green, W. D., Beck, M. A., Algaith, T., Herbst, C. H., Alsukait, R. F., Alluhidan, M., Alazemi, N., & Shekar, M. (2020) · Obesity Reviews · doi:10.1111/obr.13128 · Cited by 1,150 · see citing works
Spinner, C. D., Gottlieb, R., Criner, G. J., Arribas, J. R., Cattelan, A. M., Soriano, À., Ogbuagu, O. E., Malhotra, P., Mullane, K. M., Castagna, A., et al. (2020) · JAMA · doi:10.1001/jama.2020.16349 · Cited by 1,217 · see citing works
Xu, S., Ilyas, I., Little, P. J., Li, H., Kamato, D., Zheng, X., Luo, S., Li, Z., Liu, P., Han, J., et al. (2021) · Pharmacological Reviews · doi:10.1124/pharmrev.120.000096 · Cited by 1,167 · see citing works
“Other emerging drugs with therapeutic potential include anticoagulant drugs (Paar et al., 2021), dexamethasone (Horby et al., 2021), canakinumab (an anti–IL-1b monoclonal antibody) (Ucciferri et al., 2020), adrecizumab (an anti-adrenomedullin antibody) (Karakas et al., 2020), and NLRP3 inflammasome…”
BackgroundDrug treatments for covid-19: living systematic review and network meta-analysis
Siemieniuk, R. A., Bartoszko, J. J., Zeraatkar, D., Kum, E., Qasim, A., Díaz Martinez, J. P., Izcovich, A., Rochwerg, B., Lamontagne, F., Han, M. A., et al. (2020) · BMJ · doi:10.1136/bmj.m2980 · Cited by 846 · see citing works
A dynamic COVID-19 immune signature includes associations with poor prognosis
Laing, A. G., Lorenc, A., del Molino del Barrio, I., Das, A., Fish, M., Monin, L., Muñoz-Ruiz, M., McKenzie, D. R., Hayday, T. S., Francos-Quijorna, I., et al. (2020) · Nature Medicine · doi:10.1038/s41591-020-1038-6 · Cited by 946 · see citing works
International consensus statement on allergy and rhinology: rhinosinusitis 2021
Orlandi, R. R., Kingdom, T. T., Smith, T. L., Bleier, B. S., DeConde, A. S., Luong, A., Poetker, D. M., Soler, Z. M., Welch, K. C., Wise, S. K., et al. (2020) · International Forum of Allergy & Rhinology · doi:10.1002/alr.22741 · Cited by 1,051 · see citing works
Extrafollicular B cell responses correlate with neutralizing antibodies and morbidity in COVID-19
Woodruff, M. C., Ramonell, R. P., Nguyen, D. C., Cashman, K. S., Saini, A. S., Haddad, N. S., Ley, A. M., Kyu, S., Howell, J. C., Ozturk, T., et al. (2020) · Nature Immunology · doi:10.1038/s41590-020-00814-z · Cited by 791 · see citing works
Neutralizing monoclonal antibodies for treatment of COVID-19
Taylor, P. C., Adams, A. C., Hufford, M. M., de la Torre, I., Winthrop, K., & Gottlieb, R. L. (2021) · Nature Reviews Immunology · doi:10.1038/s41577-021-00542-x · Cited by 732 · see citing works
Koehler, P. A., Bassetti, M., Chakrabarti, A., Chen, S. C. ‐., Colombo, A. L., Hoenigl, M., Климко, Н. Н., Lass‐Flörl, C., Oladele, R. O., Vinh, D. C., et al. (2020) · The Lancet Infectious Diseases · doi:10.1016/s1473-3099(20)30847-1 · Cited by 956 · see citing works
Effect of Hydrocortisone on Mortality and Organ Support in Patients With Severe COVID-19
Angus, D. C., Derde, L. P. G., Al-Beidh, F., Annane, D., Arabi, Y. M., Beane, A., van Bentum-Puijk, W., Berry, L. R., Bhimani, Z., Bonten, M. J. M., et al. (2020) · JAMA · doi:10.1001/jama.2020.17022 · Cited by 845 · see citing works
“Median (IQR) 18 (10-23) 17 (12-24) 15 (12-21)”
Self-citationCOVID-19 and the human innate immune system
Schultze, J. L., & Aschenbrenner, A. C. (2021) · Cell · doi:10.1016/j.cell.2021.02.029 · Cited by 714 · see citing works
“…shown to be beneficial, particularly in patients with severe disease courses where it reduced 28-day mortality in randomized clinical trials (RECOVERY Collaborative Group et al., 2021; Tomazini et al., 2020; WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group et al., 2020).”
BackgroundLeisman, D. E., Ronner, L., Pinotti, R., Taylor, M. D., Sinha, P., Calfee, C. S., Hirayama, A. V. V., Mastroianni, F., Turtle, C. J., Harhay, M. O., et al. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30404-5 · Cited by 849 · see citing works
COVID-ICU Group on behalf of the REVA Network and the COVID-ICU Investigators (2020) · Intensive Care Medicine · doi:10.1007/s00134-020-06294-x · Cited by 913 · see citing works
“Notably, 28-day mortality was 41% in the control care group of the RECOVERY trial, which showed that dexamethasone improved the survival of patients receiving invasive mechanical ventilation or oxygen at randomization [6].”
BackgroundSalvarani, C., Dolci, G., Massari, M., Merlo, D. F., Cavuto, S., Savoldi, L., Bruzzi, P., Boni, F., Braglia, L., Turrà, C., et al. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.6615 · Cited by 684 · see citing works
“Patients were randomized after a median (interquartile range) time from symptom onset of 8 (6-11) days.”
MethodCircuits between infected macrophages and T cells in SARS-CoV-2 pneumonia
Grant, R. A., Morales‐Nebreda, L., Markov, N. S., Swaminathan, S., Querrey, M., Rios-Guzman, E., Abbott, D. A., Donnelly, H. K., Donayre, A., Goldberg, I. A., et al. (2021) · Nature · doi:10.1038/s41586-020-03148-w · Cited by 703 · see citing works
Horby, P., Mafham, M. M., Bell, J. L., Linsell, L., Staplin, N., Emberson, J., Palfreeman, A., Raw, J., Elmahi, E., Prudon, B., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)32013-4 · Cited by 708 · see citing works
Self-citationIzcovich, A., Ragusa, M. A., Tortosa, F. G., Marzio, M. A. L., Agnoletti, C., Bengolea, A., Ceirano, A., Espinosa, F., Saavedra, E., Sanguine, V., et al. (2020) · PLoS ONE · doi:10.1371/journal.pone.0241955 · Cited by 658 · see citing works
Halpin, D. M. G., Criner, G. J., Papi, A. A., Singh, D., Anzueto, A., Martínez, F. J., Agusti, A. A., & Vogelmeier, C. F. (2020) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202009-3533so · Cited by 774 · see citing works
Immunity, endothelial injury and complement-induced coagulopathy in COVID-19
Perico, L., Benigni, A., Casiraghi, F., Ng, L. F. P., Rénia, L., & Remuzzi, G. (2020) · Nature Reviews Nephrology · doi:10.1038/s41581-020-00357-4 · Cited by 603 · see citing works
Gupta, S., Wang, W., Hayek, S. S., Chan, L., Mathews, K. S., Melamed, M. L., Brenner, S. K., Leonberg-Yoo, A., Schenck, E. J., Radbel, J., et al. (2021) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.6252 · Cited by 535 · see citing works
Effects of COVID-19 on the Nervous System
Iadecola, C., Anrather, J., & Kamel, H. (2020) · Cell · doi:10.1016/j.cell.2020.08.028 · Cited by 663 · see citing works
Marconi, V. C., Ramanan, A. V., de Bono, S., Kartman, C. E., Krishnan, V., Liao, R., Piruzeli, M. L. B., Goldman, J. D., Alatorre-Alexander, J., Pellegrini, R. D. C., et al. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(21)00331-3 · Cited by 730 · see citing works
“…of care changed significantly to include routine use of corticosteroids, and guidelines 28,29 were updated following the disclosure of results from the open-label RECOVERY trial in June, 2020, 30 in which a 10·9% relative reduction in mortality was observed with dexamethasone (mortality 22·9”
Rhino-Orbital Mucormycosis Associated With COVID-19
Mehta, S. A., & Pandey, A. (2020) · Cureus · doi:10.7759/cureus.10726 · Cited by 583 · see citing works
Fix, O. K., Hameed, B., Fontana, R. J., Kwok, R. M., McGuire, B. M., Mulligan, D. C., Pratt, D. S., Russo, M. W., Schilsky, M. L., Verna, E. C., et al. (2020) · Hepatology · doi:10.1002/hep.31281 · Cited by 473 · see citing works
Global pandemics interconnected — obesity, impaired metabolic health and COVID-19
Stefan, N., Birkenfeld, A. L., & Schulze, M. B. (2021) · Nature Reviews Endocrinology · doi:10.1038/s41574-020-00462-1 · Cited by 452 · see citing works
Organ-specific manifestations of COVID-19 infection
Gavriatopoulou, M., Korompoki, E., Fotiou, D., Ntanasis‐Stathopoulos, I., Ψαλτοπούλου, Θ., Kastritis, E., Terpos, E., & Dimopoulos, M. A. (2020) · Clinical and Experimental Medicine · doi:10.1007/s10238-020-00648-x · Cited by 497 · see citing works
Dequin, P., Heming, N., Meziani, F., Plantefève, G., Voiriot, G., Badie, J. C., François, B., Aubron, C., Ricard, J.-D., Ehrmann, S., et al. (2020) · JAMA · doi:10.1001/jama.2020.16761 · Cited by 505 · see citing works
Artificial intelligence in COVID-19 drug repurposing
Zhou, Y., Wang, F., Tang, J., Nussinov, R., & Cheng, F. (2020) · The Lancet Digital Health · doi:10.1016/s2589-7500(20)30192-8 · Cited by 636 · see citing works
Veiga, V. C., Prats, J. A. G. G., Farias, D. L. C., Rosa, R. G., Dourado, L. K., Zampieri, F. G., Machado, F. R., Lopes, R. D., Berwanger, O., Azevedo, L. C. P., et al. (2021) · BMJ · doi:10.1136/bmj.n84 · Cited by 388 · see citing works
Obesity as a multisystem disease: Trends in obesity rates and obesity‐related complications
Sarma, S., Sockalingam, S., & Dash, S. (2021) · Diabetes Obesity and Metabolism · doi:10.1111/dom.14290 · Cited by 461 · see citing works
Chai, K. L., Valk, S. J., Piechotta, V., Kimber, C., Monsef, I., Doree, C. J., Wood, E. M., Lamikanra, A., Roberts, D. J., McQuilten, Z., et al. (2020) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd013600.pub3 · Cited by 148 · see citing works
Thrombocytopathy and endotheliopathy: crucial contributors to COVID-19 thromboinflammation
Gu, S. X., Tyagi, T., Jain, K., Gu, V. W., Lee, S. H., Hwa, J. M., Kwan, J. M., Krause, D. S., Lee, A. I., Halene, S., et al. (2020) · Nature Reviews Cardiology · doi:10.1038/s41569-020-00469-1 · Cited by 414 · see citing works
Specialized pro-resolving mediator network: an update on production and actions
Chiang, N., & Serhan, C. N. (2020) · Essays in Biochemistry · doi:10.1042/ebc20200018 · Cited by 441 · see citing works
C-reactive protein and clinical outcomes in patients with COVID-19
Smilowitz, N. R., Kunichoff, D. F., Garshick, M. S., Shah, B., Pillinger, M. H., Hochman, J. S., & Berger, J. S. (2020) · European Heart Journal · doi:10.1093/eurheartj/ehaa1103 · Cited by 442 · see citing works
“In a separate analysis of 1400 patients hospitalized with COVID-19, IL-6 and tumour necrosis factor (TNF)-a cytokine levels at the time of hospitalization were associated with survival after adjustment for clinical comorbidities and CRP, D-dimer, and ferritin concentrations.22 These data confirm the observed relations…”
BackgroundInfluentialCOVID-19: Discovery, diagnostics and drug development
Asselah, T., Durantel, D., Pasmant, É., Lau, G., & Schinazi, R. (2020) · Journal of Hepatology · doi:10.1016/j.jhep.2020.09.031 · Cited by 366 · see citing works
“In a controlled, open-label trial of patients hospitalised with COVID-19, patients were randomly assigned to receive oral or intravenous dexamethasone (6 mg once daily) for up to 10 days or to receive SOC alone.(136) In the dexamethasone group, the incidence of death was lower than that in the SOC group among patients…”
MethodInfluenza virus and SARS-CoV-2: pathogenesis and host responses in the respiratory tract
Flerlage, T., Boyd, D. F., Meliopoulos, V., Thomas, P. G., & Schultz‐Cherry, S. (2021) · Nature Reviews Microbiology · doi:10.1038/s41579-021-00542-7 · Cited by 406 · see citing works
Ramakrishnan, S., Nicolau, D. V., Langford, B., Mahdi, M., Jeffers, H., Mwasuku, C. M., Krassowska, K., Fox, R. A., Binnian, I., Glover, V., et al. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(21)00160-0 · Cited by 415 · see citing works
Cruz, A. S., Mendes‐Frias, A., Oliveira, A. I., Dias, L., Matos, A. R., Carvalho, A., Capela, C., Pedrosa, J., Castro, A. G., & Silvestre, R. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.613422 · Cited by 355 · see citing works
“Active Neoplasia 1 (20) 3 (20) 1 (9) 0.”
BackgroundResultInfluentialHenderson, L. A., Canna, S., Friedman, K. G., Gorelik, M., Lapidus, S., Bassiri, H., Behrens, E. M., Ferris, A. M., Kernan, K. F., Schulert, G. S., et al. (2020) · Arthritis & Rheumatology · doi:10.1002/art.41616 · Cited by 412 · see citing works
“Importantly, results from a large randomized controlled trial (the RECOVERY trial) indicate that low-to-moderate–dose dexamethasone significantly reduced mortality in COVID-19 patients requiring mechanical ventilation (102).”
BackgroundPost coronavirus disease mucormycosis: a deadly addition to the pandemic spectrum
Sharma, S., Grover, M., Bhargava, S., Samdani, S. K., & Kataria, T. (2021) · The Journal of Laryngology & Otology · doi:10.1017/s0022215121000992 · Cited by 399 · see citing works
Coronavirus breakthrough: dexamethasone is first drug shown to save lives
Ledford, H. K. (2020) · Nature · doi:10.1038/d41586-020-01824-5 · Cited by 356 · see citing works
Akiyama, S., Hamdeh, S., Micić, D., & Sakuraba, A. (2020) · Annals of the Rheumatic Diseases · doi:10.1136/annrheumdis-2020-218946 · Cited by 383 · see citing works
Jerônimo, C. M. P., de Farias, M. E. L., Val, F., Sampaio, V. D. S., Alexandre, M. A. A., de Melo, G. C., Safe, I. P., Borba, M. G. S., Netto, R. L. A., Maciel, A. B. D. S., et al. (2020) · Clinical Infectious Diseases · doi:10.1093/cid/ciaa1177 · Cited by 434 · see citing works
MacLeod, M. A., Papi, A. A., Contoli, M., Beghé, B., Celli, B. R., Wedzicha, J. A., & Fabbri, L. M. (2021) · Respirology · doi:10.1111/resp.14041 · Cited by 377 · see citing works
Moorthy, A., Gaikwad, R., Krishna, S., Hegde, R. S., Tripathi, K. K., Kale, P., Rao, P. S., Haldipur, D., & Bonanthaya, K. (2021) · Journal of Maxillofacial and Oral Surgery · doi:10.1007/s12663-021-01532-1 · Cited by 336 · see citing works
Alhazzani, W. A., Evans, L., Alshamsi, F. E., Møller, M. H., Ostermann, M., Prescott, H. C., Arabi, Y. M., Loeb, M. B., Gong, M. N., Fan, E., et al. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000004899 · Cited by 410 · see citing works
COVID-19, immunothrombosis and venous thromboembolism: biological mechanisms
Loo, J., Spittle, D. A., & Newnham, M. (2021) · Thorax · doi:10.1136/thoraxjnl-2020-216243 · Cited by 337 · see citing works
Monk, P., Marsden, R., Tear, V. J., Brookes, J. L., Batten, T. N., Mankowski, M., Gabbay, F. J., Davies, D. E., Holgate, S. T., Ho, L., et al. (2020) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(20)30511-7 · Cited by 431 · see citing works
COVID-19: A Multidisciplinary Review
Chams, N., Chams, S., Badran, R., Shams, A., Araji, A., Raad, M., Mukhopadhyay, S., Stroberg, E., Duval, E. J., Barton, L. M., et al. (2020) · Frontiers in Public Health · doi:10.3389/fpubh.2020.00383 · Cited by 401 · see citing works
“, those who did not receive any respiratory support) (109).”
BackgroundOuldali, N., Toubiana, J., Antona, D., Javouhey, É., Madhi, F., Lorrot, M., Léger, P., Galeotti, C., Claude, C., Wiedemann, A., et al. (2021) · JAMA · doi:10.1001/jama.2021.0694 · Cited by 353 · see citing works
Lessons learned 1 year after SARS-CoV-2 emergence leading to COVID-19 pandemic
To, K. K., Sridhar, S., Chiu, K. H., Hung, D. L. L., Li, X., Hung, I. F., Tam, A. R., Chung, T. W., Chan, J. F., Zhang, J., et al. (2021) · Emerging Microbes & Infections · doi:10.1080/22221751.2021.1898291 · Cited by 350 · see citing works
“methasone has been shown to reduce mortality by about 30% in patients requiring oxygen supplementation [302, 303].”
BackgroundSeverino, P., D’Amato, A., Pucci, M., Infusino, F., Adamo, F., Birtolo, L. I., Netti, L., Montefusco, G., Chimenti, C., Lavalle, C., et al. (2020) · International Journal of Molecular Sciences · doi:10.3390/ijms21218118 · Cited by 362 · see citing works
Treatment for COVID-19: An overview
Stasi, C., Silvia, F., Voller, F., & Silvestri, C. (2020) · European Journal of Pharmacology · doi:10.1016/j.ejphar.2020.173644 · Cited by 360 · see citing works
“Preliminary results (Horby et al., 2020) of the randomised RECOVERY clinical trial aimed at evaluating the efficacy of potential treatments for COVID-19, including low-dose dexamethasone (corticosteroid), have recently been published.”
BackgroundLung transplantation for patients with severe COVID-19
Bharat, A., Querrey, M., Markov, N. S., Kim, S., Kurihara, C., Garza-Castillon, R., Manerikar, A., Shilatifard, A., Tomic, R., Politanska, Y., et al. (2020) · Science Translational Medicine · doi:10.1126/scitranslmed.abe4282 · Cited by 336 · see citing works
Lim, Z. J., Subramaniam, A., Reddy, M. P., Blecher, G., Kadam, U., Afroz, A., Billah, B., Ashwin, S., Kubicki, M. A., Bilotta, F., et al. (2020) · American Journal of Respiratory and Critical Care Medicine · doi:10.1164/rccm.202006-2405oc · Cited by 372 · see citing works
“Although there have been promising therapies such as remdesivir (4) and dexamethasone (5), mechanical ventilation continues to be the mainstay of management of severe COVID-19 (6).”
BackgroundFurtado, R. H. M., Berwanger, O. B., Fonseca, H. A. R., Corrêa, T. D., Ferraz, L. J. R., Lapa, M. G., Zampieri, F. G., Veiga, V. C., Azevedo, L. C. P., Rosa, R. G., et al. (2020) · The Lancet · doi:10.1016/s0140-6736(20)31862-6 · Cited by 360 · see citing works
Racial Disparities-Associated COVID-19 Mortality among Minority Populations in the US
Alcendor, D. J. (2020) · Journal of Clinical Medicine · doi:10.3390/jcm9082442 · Cited by 334 · see citing works
“If corticosteroid therapy is recommended for COVID-19 patients, glucose levels should be monitored carefully to avoid pulmonary and immune dysfunction [50,51] (Figure 1).”
BackgroundSong, W., Hui, C., Hull, J. H., Birring, S. S., McGarvey, L. P., Mazzone, S. B., & Chung, K. F. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(21)00125-9 · Cited by 376 · see citing works
“London, UK: The COVID-19 Body Politic Slack Group, 2020. https://patientresearchcovid19.com/research/report-1/ (accessed Sept 24, 2020).”
Iftimie, S., López-Azcona, A. F., Vallverdú, I., Hernández-Flix, S., de Febrer, G., Parra, S., Hernández-Aguilera, A., Riu, F., Joven, J., Andreychuk, N., et al. (2020) · medRxiv · doi:10.1371/journal.pone.0248029 · Cited by 286 · see citing works
Disease severity-specific neutrophil signatures in blood transcriptomes stratify COVID-19 patients
(DeCOI), G. C.-1. O. I., Aschenbrenner, A. C., Mouktaroudi, M., Krämer, B., Oestreich, M., Antonakos, N., Nuesch-Germano, M., Gkizeli, K., Bonaguro, L., Reusch, N., et al. (2021) · Genome Medicine · doi:10.1186/s13073-020-00823-5 · Cited by 255 · see citing works
“First study reports have recently declared strong benefit for dexamethasone treatment in severe COVID-19 cases requiring intubation, while no effect on mortality was seen for those patients who did not require respiratory support [23, 92].”
BackgroundBardi, T., Pintado, V., Rojo, M. G., Escudero-Sánchez, R., López, A. A., Díez-Remesal, Y., Castro, N. M., Ruíz-Garbajosa, P., & Pestaña, D. (2021) · European Journal of Clinical Microbiology & Infectious Diseases · doi:10.1007/s10096-020-04142-w · Cited by 336 · see citing works
“The Recovery Trial which has shown the most promising data regarding the use of glucocorticoids in COVID-19, has not published results regarding the occurrence of nosocomial infection and their association with steroid treatment [24].”
BackgroundLeung, J. M., Niikura, M., Yang, C. W. T., & Sin, D. D. (2020) · European Respiratory Journal · doi:10.1183/13993003.02108-2020 · Cited by 286 · see citing works
“So far, the most promising preliminary data on corticosteroids and COVID-19 are from a randomised controlled trial of dexamethasone (RECOVERY) performed in the UK, which demonstrated a one-third reduction in mortality [75].”
Emerging treatment strategies for COVID-19 infection
Gavriatopoulou, M., Ntanasis‐Stathopoulos, I., Korompoki, E., Fotiou, D., Migkou, M., Tzanninis, I., Ψαλτοπούλου, Θ., Kastritis, E., Terpos, E., & Dimopoulos, M. A. (2020) · Clinical and Experimental Medicine · doi:10.1007/s10238-020-00671-y · Cited by 326 · see citing works
“The recently published Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial, an open label randomized controlled trial compering dexamethasone (6 mg daily for 10 days) versus standard of care, terminated enrollment early due to a mortality benefit with dexamethasone [82].”
BackgroundThe Role and Therapeutic Potential of NF-kappa-B Pathway in Severe COVID-19 Patients
Hariharan, A., Hakeem, A. R., Radhakrishnan, S., Reddy, M. S., & Rela, M. (2020) · Inflammopharmacology · doi:10.1007/s10787-020-00773-9 · Cited by 300 · see citing works
Clinical criteria for COVID-19-associated hyperinflammatory syndrome: a cohort study
Webb, B. J., Peltan, I. D., Jensen, P., Hoda, D., Hunter, B. D., Silver, A. E., Starr, N. J., Buckel, W. R., Grisel, N., Hummel, E., et al. (2020) · The Lancet Rheumatology · doi:10.1016/s2665-9913(20)30343-x · Cited by 292 · see citing works
A materials-science perspective on tackling COVID-19
Tang, Z., Kong, N., Zhang, X., Liu, Y., Hu, P., Mou, S., Liljeström, P., Shi, J., Tan, W., Kim, J. S., et al. (2020) · Nature Reviews Materials · doi:10.1038/s41578-020-00247-y · Cited by 302 · see citing works
Bravata, D. M., Perkins, A. J., Myers, L. J., Arling, G. W., Zhang, Y., Zillich, A. J., Reese, L. J., Dysangco, A. T., Agarwal, R., Myers, J. L., et al. (2021) · JAMA Network Open · doi:10.1001/jamanetworkopen.2020.34266 · Cited by 442 · see citing works
“6) APACHE score, median (IQR)d 12 (6-21) 13 (6-22) 12 (5-20) 10 (4-17) 10 (4-19) 10 (4-18) <.”
Corticosteroids in COVID-19 and non-COVID-19 ARDS: a systematic review and meta-analysis
Chaudhuri, D., Sasaki, K., Karkar, A., Sharif, S., Lewis, K., Mammen, M. J., Alexander, P. E., Ye, Z., Lozano, L. E. C., Munch, M. W., et al. (2021) · Intensive Care Medicine · doi:10.1007/s00134-021-06394-2 · Cited by 297 · see citing works
Reusch, N., Domenico, E. D., Bonaguro, L., Schulte-Schrepping, J., Bassler, K. E., Schultze, J. L., & Aschenbrenner, A. C. (2021) · Frontiers in Immunology · doi:10.3389/fimmu.2021.652470 · Cited by 251 · see citing works
“Corticosteroids are a currently recommended treatment for severe COVID-19 (104) shown to reduce neutrophils’ respiratory burst and recruitment to the inflamed tissue at system level (105) and inhaled glucocorticoids have been shown to reduce NET formation in asthma patients (106).”
BackgroundBiran, N., Ip, A., Ahn, J., Go, R. C., Wang, S., Mathura, S., Sinclaire, B., Bednarz, U., Marafelias, M., Hansen, E., et al. (2020) · The Lancet Rheumatology · doi:10.1016/s2665-9913(20)30277-0 · Cited by 274 · see citing works
Obesity: A critical risk factor in the COVID ‐19 pandemic
Kwok, S., Adam, S., Ho, J. H., Iqbal, Z., Turkington, P. M., Razvi, S., le Roux, C. W., Soran, H., & Syed, A. A. (2020) · Clinical Obesity · doi:10.1111/cob.12403 · Cited by 254 · see citing works
“82).(118) However, dexamethasone treatment in this context is likely to work via its anti-inflammatory and immunomodulatory”
BackgroundZhou, S., Butler‐Laporte, G., Nakanishi, T., Morrison, D., Afilalo, J., Afilalo, M., Laurent, L., Pietzner, M., Kerrison, N. D., Zhao, K., et al. (2021) · Nature Medicine · doi:10.1038/s41591-021-01281-1 · Cited by 273 · see citing works
Chalmers, J., Polverino, E., Crichton, M., et al. (2023) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(23)00093-0 · Cited by 243
Remdesivir against COVID-19 and Other Viral Diseases
Malin, J. J., Suárez, I., Priesner, V., Fätkenheuer, G., & Rybniker, J. (2020) · Clinical Microbiology Reviews · doi:10.1128/cmr.00162-20 · Cited by 296 · see citing works
An update on COVID-19 pandemic: the epidemiology, pathogenesis, prevention and treatment strategies
Tsang, H. F., Chan, L., Cho, W. C. S., Yu, A. C.-S., Yim, A. K., Chan, A. K. C., Ng, L. P. W., Wong, Y. K. E., Pei, X. M., Li, M. J. W., et al. (2020) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2021.1863146 · Cited by 313 · see citing works
Dennis, J. M., McGovern, A. P., Vollmer, S. J., & Mateen, B. A. (2021) · Critical Care Medicine · doi:10.1097/ccm.0000000000004747 · Cited by 214 · see citing works
“Of particular note regarding treatment, the RECOVERY trial began nationwide recruitment in early April, and included dexamethasone which was later shown to have mortality-specific, or length of intensive treatment unit admission-specific benefits, as well as azithromycin, tocilizumab, and convalescent plasma (8).”
BackgroundRahman, S., Montero, M. T. V., Rowe, K., Kirton, R., & Kunik, F. (2021) · Expert Review of Clinical Pharmacology · doi:10.1080/17512433.2021.1902303 · Cited by 299 · see citing works
“that dexamethasone reduced mortality by one-third in critically ill COVID-19 patients [184,185].”
BackgroundEmerging evidence of a COVID-19 thrombotic syndrome has treatment implications
Merrill, J. T., Erkan, D., Winakur, J., & James, J. A. (2020) · Nature Reviews Rheumatology · doi:10.1038/s41584-020-0474-5 · Cited by 228 · see citing works
Asch, D. A., Sheils, N. E., Islam, M. N., Chen, Y., Werner, R. M., Buresh, J., & Doshi, J. A. (2020) · JAMA Internal Medicine · doi:10.1001/jamainternmed.2020.8193 · Cited by 245 · see citing works
Hasan, S. S., Capstick, T., Ahmed, R., Kow, C. S., Mazhar, F., Merchant, H. A., & Zaidi, S. T. R. (2020) · Expert Review of Respiratory Medicine · doi:10.1080/17476348.2020.1804365 · Cited by 283 · see citing works
“Recently, the release of the results from a randomized controlled trial (RECOVERY [99]) on the use of dexamethasone demonstrated mortality benefits in a subset of COVID-19 patients receiving respiratory support, which supports the findings of this systematic review and metaanalysis, though the data from RECOVERY trial…”
ResultHenderson, L. A., Canna, S., Friedman, K. G., Gorelik, M., Lapidus, S., Bassiri, H., Behrens, E. M., Kernan, K. F., Schulert, G. S., Seo, P., et al. (2022) · Arthritis & Rheumatology · doi:10.1002/art.42062 · Cited by 297 · see citing works
Impact of COVID-19 on the thyroid gland: an update
Scappaticcio, L., Pitoia, F., Esposito, K., Piccardo, A., & Trimboli, P. (2020) · Reviews in Endocrine and Metabolic Disorders · doi:10.1007/s11154-020-09615-z · Cited by 270 · see citing works
Repurpose Open Data to Discover Therapeutics for COVID-19 Using Deep Learning
Zeng, X., Song, X. H., Ma, T., Pan, X., Zhou, Y., Hou, Y., Zhang, Z., Li, K., Karypis, G., & Cheng, F. (2020) · Journal of Proteome Research · doi:10.1021/acs.jproteome.0c00316 · Cited by 258 · see citing works
A time-resolved proteomic and prognostic map of COVID-19
Demichev, V., Tober-Lau, P., Lemke, O., Nazarenko, T., Thibeault, C., Whitwell, H., Röhl, A., Freiwald, A., Szyrwiel, L., Ludwig, D., et al. (2021) · Cell Systems · doi:10.1016/j.cels.2021.05.005 · Cited by 200 · see citing works
“The measurements were performed on samples collected during the early period of COVID-19, i.e., before immunomodulatory treatments such as dexamethasone became standard of care for severe COVID19 (RECOVERYCollaborative Group, 2020).”
BackgroundConvalescent Plasma for COVID-19. A randomized clinical trialPreprint
Gharbharan, A., Jordans, C., GeurtsvanKessel, C. H., et al. (2020) · medRxiv · doi:10.1101/2020.07.01.20139857 · Cited by 220 · see citing works
Thwaites, R. S., Uruchurtu, A. S. S., Siggins, M. K., Liew, F., Russell, C. D., Moore, S. C., Fairfield, C. J., Carter, E., Abrams, S. T., Short, C.-E. S., et al. (2021) · Science Immunology · doi:10.1126/sciimmunol.abg9873 · Cited by 227 · see citing works
“beneficial effect of corticosteroids (6, 7) and IL-6 receptor antagonists (8) in severe COVID-19 indicates that immune inhibition can be beneficial at advanced stages of disease and that”
BackgroundSelf-citationConfronting the controversy: interleukin-6 and the COVID-19 cytokine storm syndrome
Chen, L. Y. C., Hoiland, R. L., Stukas, S. K., Wellington, C. L., & Sekhon, M. S. (2020) · European Respiratory Journal · doi:10.1183/13993003.03006-2020 · Cited by 240 · see citing works
Tardif, J., Bouabdallaoui, N., L’Allier, P. L., Gaudet, D., Shah, B., Pillinger, M. H., López-Sendón, J. L., da Luz, P. L., Verret, L., Audet, S., et al. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(21)00222-8 · Cited by 354 · see citing works
Deciphering the COVID‐19 cytokine storm: Systematic review and meta‐analysis
Mulchandani, R., Lyngdoh, T., & Kakkar, A. K. (2020) · European Journal of Clinical Investigation · doi:10.1111/eci.13429 · Cited by 242 · see citing works
Association of Convalescent Plasma Treatment With Clinical Outcomes in Patients With COVID-19
Janiaud, P., Axfors, C., Schmitt, A. M., Gloy, V., Ebrahimi, F., Hepprich, M., Smith, E. R., Haber, N., Khanna, N., Moher, D., et al. (2021) · JAMA · doi:10.1001/jama.2021.2747 · Cited by 239 · see citing works
Azithromycin in the treatment of COVID-19: a review
Echeverría-Esnal, D., Martín‐Ontiyuelo, C., Navarrete-Rouco, M. E., de Antonio-Cuscó, M., Ferrández, O., Horcajada, J. P., & Grau, S. (2020) · Expert Review of Anti-infective Therapy · doi:10.1080/14787210.2020.1813024 · Cited by 244 · see citing works
Gikandi, S. (2019) · How Literatures Begin · doi:10.18772/12019093900.4 · Cited by 209
“, remdesivir [5] ; hydroxychloroquine [17] ; dexamethasone [20] ; and/or resort to traditional medicine (TM) [3 , 12 , 22 , 23 , 39 , 40] .”
Kory, P., Meduri, G. U., Varon, J., Iglesias, J., & Marik, P. E. (2021) · American Journal of Therapeutics · doi:10.1097/mjt.0000000000001377 · Cited by 203 · see citing works
Bharat, A., Machuca, T., Querrey, M., Kurihara, C., Garza‐Castillon, R., Kim, S., Manerikar, A. J., Peláez, A., Pipkin, M., Shahmohammadi, A., et al. (2021) · The Lancet Respiratory Medicine · doi:10.1016/s2213-2600(21)00077-1 · Cited by 230 · see citing works
- Authors
- Horby, P., Lim, W. S., Emberson, J., Mafham, M., Bell, J., Linsell, L., Staplin, N., Brightling, C., Ustianowski, A., Elmahi, E., Prudon, B., Green, C., Felton, T., Chadwick, D., Rege, K., Fegan, C., Chappell, L. C., Faust, S. N., Jaki, T., Jeffery, K., Montgomery, A., Rowan, K., Juszczak, E., Baillie, J. K., Haynes, R., Landray, M. J., & RECOVERY Collaborative Group
- Affiliations
- University of Oxford (GB)
- Nottingham University Hospitals NHS Trust (GB)
- University of Leicester (GB)
- North Manchester General Hospital (GB)
- Northampton General Hospital (GB)
- North Tees and Hartlepool NHS Foundation Trust (GB)
- University Hospitals Birmingham NHS Foundation Trust (GB)
- James Cook University Hospital (GB)
- King's College London (GB)
- University Hospital Southampton NHS Foundation Trust (GB)
- University of Cambridge (GB)
- Oxford University Hospitals NHS Trust (GB)
- University of Nottingham (GB)
- Intensive Care National Audit & Research Centre (GB)
- Roslin Institute (GB)
- Corresponding author
- Horby, Peter
- Landray, Martin J
- ORCID
- Venue
- New England Journal of Medicine
- Publisher
- openRxiv
- Published
- 2020-06-22
- Volume
- 384
- Issue
- 8
- Pages
- 693-704
- ISSN
- 0028-4793 (ISSN-L)
- PMC
- PMC7383595
- OpenAlex
- W3042270788
- Cited by
- 11,475
- References
- 39
- Citations by year
- 2026: 299 · 2025: 573 · 2024: 932 · 2023: 1534 · 2022: 2623 · 2021: 3849 · 2020: 1651 · 2018: 2 · 2017: 1 · 2014: 1 · 2012: 1
- FWCI
- 317.25
- Type
- journal article
- Language
- en
- Open access
- green
- doi.org
- Licence
- cc-by
- 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
- Bill and Melinda Gates Foundation
- Wellcome Trust (222406/Z/21/Z)
- UK Research and Innovation (MC_PC_19056)
- Cancer Research UK (25350)
- National Institute for Health and Care Research (MC_PC_19056, RP-2016-07-012, ACF-2020-06-012, NIHR201409, NIHR202424, 11/46/14, CL-2018-13-007, NIHR-INF-1074, ACF-2016-14-002, NIHR200268, ACF-2019-13-003, RP-2014-05-019, SRF-2015-08-001, NIHR300669, ACF-2017-24-501, ACF-2019-06-012, ACF-2020-11-003)
- Department of Health and Social Care
- Kidney Research UK (TF_009_20181123)
- Academy of Medical Sciences (AMS-CSF4-Torok)
- University of Oxford
- Public Health England
- Department for International Development
- Medical Research Council (MC_UU_0002/14, MR/K025643/1, MC_UU_00017/3, MR/S001751/1, 1790394, MR/T005114/1, MC_PC_20062, MC_PC_19056)
- Biotechnology and Biological Sciences Research Council (BBS/E/D/30002277, BBS/E/D/20002174)
- NIHR Oxford Biomedical Research Centre
- NIHR Nottingham Biomedical Research Centre
- Health Data Research UK
- NIHR Academy (SRF-2015-08-001)
- 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
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
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