Title: Dexamethasone: Improving Mortality in COVID-19?<br/>Author: Kami Windsor<br/><a href='http://umem.org/profiles/faculty/742/'>[Click to email author]</a><hr/><p>
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        The RECOVERY (<strong>R</strong>andomized <strong>E</strong>valuation of <strong>COV</strong>id-19 th<strong>ER</strong>ap<strong>Y</strong>) investigators recently published a non-peer reviewed article on their findings utilizing dexamethasone to treat patients with COVID-19. </p>
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        Rx: Dexamethasone 6mg daily* x 10 days (PO or IV) <span style="font-size:9px;">*or steroid equivalent</span></p>
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                2104 in the dexamethasone group vs 4321 in the “usual care” group</li>
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                Did not exclude children or pregnant/breastfeeding mothers</li>
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                Follow-up at 28 days, hospital discharge, or death</li>
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        Primary outcome:         All-cause mortality at 28-days</p>
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        Secondary outcomes: </p>
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                Major arrhythmia</li>
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                Time to discharge from hospital</li>
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                Duration of mechanical ventilation</li>
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                Need for renal replacement therapy</li>
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                In patients not ventilated at enrollment, need for intubation/ECMO & death</li>
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        Results:</p>
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        <img alt="" src="http://umem.org/files/uploads/content/pearls/Critical_Care/RECOVERY%20dexamethasone%20table.png" style="height: 150px; width: 364px;" /></p>
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                <strong>Decrease in overall mortality at 28-days with 3% absolute risk reduction.</strong>
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                                <strong>NNT of 25</strong> in patients requiring O2, HFNC, or NIV</li>
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                                <strong>NNT of 8</strong> in patients requiring invasive mechanical ventilation</li>
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                More mortality benefit seen the higher the respiratory support required, with no benefit and apparent trend towards<em> increased mortality</em> in the group not requiring any respiratory support at all. </li>
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                When stratified by symptoms < or > 7 days, mortality benefit only seen in the >7 days group (which was more of the ventilated patients).</li>
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                Less progression to intubation, shorter hospital duration, greater likelihood of hospital discharge.</li>
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        Limitations:</p>
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                Not yet peer-reviewed, haven't seen all the data, additional analyses could be helpful in determining if treatment effect is real</li>
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                Unblinded study</li>
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                7% of control group received dexamethasone</li>
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        <strong>Bottom Line: </strong>Strongly consider admininstering dexamethasone to your patients with known COVID-19 who require respiratory support, and look for the peer-reviewed publication from the RECOVERY Trial investigators.</p>
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<fieldset><legend>References</legend>

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        Horby P, Lim WS, Emberson et al. Effect of Dexamethasone in Hospitalized Patients with COVID-19: Preliminary Report. <a href="https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1">https://www.medrxiv.org/content/10.1101/2020.06.22.20137273v1</a> (Accessed July 14^th, 2020)</p>
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