What is the recommended duration of dexamethasone (corticosteroid) therapy for Coronavirus disease 2019 (COVID-19)?

From the Guidelines

The recommended duration of dexamethasone treatment for COVID-19 is typically 10 days or until hospital discharge, whichever comes first, as supported by the most recent and highest quality study 1. The standard regimen is 6 mg once daily, administered either orally or intravenously. This treatment is specifically indicated for hospitalized patients requiring supplemental oxygen or mechanical ventilation, as it has been shown to reduce mortality in this population, with the greatest benefit seen in patients requiring mechanical ventilation 1.

Key Considerations

• Dexamethasone works by suppressing the excessive inflammatory response that occurs in severe COVID-19, which can damage the lungs and other organs.
• It's essential to note that dexamethasone is not recommended for patients with mild COVID-19 who don't require oxygen therapy, as it may actually be harmful in these cases by potentially suppressing beneficial immune responses 1.
• Side effects may include hyperglycemia, secondary infections, and psychiatric effects, so patients should be monitored accordingly during treatment.

Patient Selection

• The benefit of dexamethasone appears greatest in patients with more severe disease, particularly those requiring mechanical ventilation 1.
• Patients with mild COVID-19 who do not require oxygen therapy should not receive dexamethasone due to the potential for harm 1.

Treatment Duration

• The treatment duration of 10 days or until hospital discharge is based on the RECOVERY trial, which demonstrated a significant reduction in mortality with dexamethasone treatment in patients receiving invasive mechanical ventilation or supplemental oxygen 1.
• However, a more recent study suggests that the mortality benefit associated with glucocorticoid therapy may not be significant when using a random-effects model and accounting for study design 1.
• Despite this, the current recommendation remains to use dexamethasone for 10 days or until hospital discharge, due to the lack of more recent and higher quality evidence to support alternative treatment durations.

From the Research

Dexamethasone Therapy Duration for COVID-19

The recommended duration of dexamethasone therapy for Coronavirus disease 2019 (COVID-19) is typically up to 10 days, as reported in several studies 2, 3, 4, 5, 6.

Key Findings

• A study published in Pulmonary pharmacology & therapeutics found that dexamethasone 6 mg once daily for up to 10 days reduces the 28-day mortality in patients with COVID-19 receiving respiratory support 2.
• The REMED trial protocol reported that dexamethasone 6 mg per day is currently recommended for patients with COVID-19 pneumonia in need of oxygen therapy or mechanical ventilation, with a treatment duration of 10 days 3.
• A prospective cohort study published in The Egyptian journal of internal medicine compared the clinical outcome and laboratory results of patients treated with dexamethasone 6 mg/day versus methylprednisolone 2 mg/kg/day infusion for 10 days 4.
• A three-arm randomized clinical trial published in Pharmacological reports compared the efficacy and safety of different doses of dexamethasone in the treatment of COVID-19, with treatment durations of up to 10 days or until hospital discharge 5.
• A population pharmacokinetic and pharmacodynamic modeling and simulation study published in Clinical and translational science found that dexamethasone given at a dose of 6 mg once-daily for 10 days is a recommended dosing regimen in patients with COVID-19 requiring oxygen therapy 6.

Treatment Duration and Dosing Regimens

• The studies suggest that a treatment duration of up to 10 days is commonly used for dexamethasone therapy in COVID-19 patients.
• Different dosing regimens have been compared, including 6 mg once daily, 8 mg once daily, 8 mg twice daily, and 12 mg daily, with varying results in terms of efficacy and safety.
• The optimal dosing regimen and treatment duration may depend on individual patient factors and the severity of COVID-19.

Summary of Main Points

• Dexamethasone therapy duration for COVID-19 is typically up to 10 days.
• Different dosing regimens have been compared, with varying results in terms of efficacy and safety.
• The optimal dosing regimen and treatment duration may depend on individual patient factors and the severity of COVID-19.