From the Guidelines
Corticosteroids, such as dexamethasone, should be used at a dose of 6 mg daily for up to 10 days in hospitalized patients with COVID-19 who require oxygen therapy, including those on mechanical ventilation.
Recommended Dosing
- The dosing of corticosteroids, specifically dexamethasone, is recommended to be 6 mg daily for up to 10 days in hospitalized patients with COVID-19 who require oxygen therapy, including those on mechanical ventilation 1.
- This recommendation is based on the results of the RECOVERY trial, which demonstrated a statistically significant reduction in mortality with corticosteroid treatment in patients receiving invasive mechanical ventilation and a lesser but still statistically significant mortality benefit in those requiring supplementary oxygen 1.
Patient Selection
- The use of corticosteroids is recommended for patients with severe or critical COVID-19, including those requiring mechanical ventilation or oxygen therapy 1.
- However, there is no mortality benefit evident in patients that do not require supplementary oxygen, and the use of corticosteroids in these patients may even be associated with harm 1.
Safety and Efficacy
- The safety and efficacy of corticosteroids in patients with COVID-19 have been evaluated in several studies, including the RECOVERY trial and a systematic review and meta-analysis of critically ill patients with COVID-19 1.
- While the adverse event profile of corticosteroids is well known, the available data do not show a significant increase in adverse events with the use of corticosteroids in patients with COVID-19 1.
From the Research
Recommended Dosing of Corticosteroids for COVID-19 Treatment
The recommended dosing of corticosteroids for COVID-19 treatment is a topic of ongoing research and debate. Based on the available evidence, the following points can be made:
- Low-dose corticosteroids, such as dexamethasone 6 mg once daily for 10 days, have been shown to reduce mortality and improve clinical outcomes in hospitalized COVID-19 patients 2, 3.
- High-dose corticosteroids, such as methylprednisolone 250 mg/day, may not provide additional benefits and may even increase the risk of adverse effects, such as dysglycemia and superimposed infections 3, 4.
- Pulse steroid treatment, which involves administering high-dose corticosteroids for a short period, may be an option for patients who do not respond to initial high-dose steroid treatment 5.
- The optimal dosage and duration of corticosteroid treatment for COVID-19 patients remain unclear and may depend on individual patient factors, such as disease severity and comorbidities.
Key Findings
- A study published in the Journal of Infection in Developing Countries found that low-dose corticosteroids were effective in reducing the progression of COVID-19 in hospitalized patients, with no significant difference in clinical outcomes between low-dose and high-dose treatment 2.
- A retrospective cohort study published in PLoS ONE found that high-dose steroids did not confer any mortality benefit and were associated with an increased risk of dysglycemia and superimposed infections in critically ill COVID-19 patients 3.
- A systematic review and meta-analysis published in Intensive Care Medicine found that corticosteroids probably reduce mortality in patients with ARDS, including those with COVID-19, and that longer courses of treatment may be associated with higher rates of survival 6.