What are the indications for Dexamethasone (Decadron) in COVID-19?

From the Guidelines

Dexamethasone (Decadron) is recommended for hospitalized COVID-19 patients requiring supplemental oxygen or mechanical ventilation, as it has been shown to decrease mortality in these patients. The standard regimen is 6 mg once daily for up to 10 days or until hospital discharge, whichever comes first, as supported by the RE-COVERY trial 1. This trial found that dexamethasone reduced 28-day mortality by 35% amongst patients on invasive mechanical ventilation and by 20% amongst patients on supplemental oxygen therapy with or without noninvasive ventilation.

Key Considerations

• Dexamethasone should not be used in non-hospitalized patients or those hospitalized but not requiring oxygen, as it may be harmful in these populations 1.
• The medication works by reducing the inflammatory response that causes lung damage in severe COVID-19, preventing the cytokine storm associated with severe disease progression.
• Clinicians should monitor for potential side effects including hyperglycemia, secondary infections, psychiatric effects, and gastrointestinal bleeding 1.
• Patients with diabetes require close blood glucose monitoring while on this medication.
• For pregnant patients, other corticosteroids like prednisolone may be preferred as they do not cross the placenta as readily as dexamethasone.

Administration and Monitoring

• Dexamethasone can be administered orally or intravenously depending on the patient's condition.
• The timing of administration is important, as early use in mild disease may impair viral clearance, while appropriate use in severe disease can significantly reduce mortality 1.
• Combination therapy with other immunomodulatory agents like tocilizumab or baricitinib may be considered in certain cases, but the evidence is less clear 1.

Evidence Summary

The recommendation for dexamethasone use in COVID-19 is based on the highest quality evidence available, including the RE-COVERY trial 1 and subsequent updates from the EULAR points to consider on the use of immunomodulatory therapies in COVID-19 1. These studies demonstrate the benefit of dexamethasone in reducing mortality in hospitalized patients with COVID-19 requiring supplemental oxygen or mechanical ventilation.

From the Research

Indications for Decadron in Covid

• Decadron, also known as dexamethasone, is used to treat patients with COVID-19 pneumonia, particularly those with moderate to severe acute respiratory distress syndrome (ARDS) 2, 3.
• The use of dexamethasone in COVID-19 patients has been shown to reduce mortality and improve clinical outcomes, such as increasing ventilator-free days 3.
• High-dose dexamethasone treatment has been studied in patients with COVID-19-related ARDS, with some studies suggesting improved clinical status and decreased inflammatory biomarkers 4.
• However, other studies have found that high-dose dexamethasone may not result in better clinical outcomes and may even be associated with higher mortality in certain patient groups 5.
• The optimal dose and duration of dexamethasone treatment for COVID-19 patients remains unclear, with different studies using varying regimens 2, 6, 5, 3, 4.

Patient Selection

• Patients with COVID-19 pneumonia and moderate to severe ARDS may benefit from dexamethasone treatment 2, 3.
• Patients with cardiovascular disease (CVD) may be at increased risk of poor outcomes with dexamethasone treatment 4.
• Patients requiring high-flow oxygen or noninvasive ventilation may have better outcomes with lower doses of dexamethasone 5.

Treatment Regimens

• Different studies have used varying regimens of dexamethasone, including 6 mg daily for 10 days 5, 20 mg daily for 5 days followed by 10 mg daily for 5 days 4, and 20 mg daily for 5 days followed by 10 mg daily until ICU discharge 3.
• The choice of treatment regimen may depend on the individual patient's clinical status and response to treatment 2, 6, 5, 3, 4.