TY - JOUR
T1 - Dexamethasone in hospitalized patients with Covid-19
AU - RECOVERY Collaborative Group
AU - Horby, Peter
AU - Lim, Wei Shen
AU - Emberson, Jonathan R
AU - Mafham, Marion
AU - Bell, Jennifer L
AU - Linsell, Louise
AU - Staplin, Natalie
AU - Brightling, Christopher
AU - Ustianowski, Andrew
AU - Elmahi, Einas
AU - Prudon, Benjamin
AU - Green, Christopher
AU - Felton, Timothy
AU - Chadwick, David
AU - Rege, Kanchan
AU - Fegan, Christopher
AU - Chappell, Lucy C
AU - Faust, Saul N
AU - Jaki, Thomas
AU - Jeffery, Katie
AU - Montgomery, Alan
AU - Rowan, Kathryn
AU - Juszczak, Edmund
AU - Baillie, J Kenneth
AU - Haynes, Richard
AU - Landray, Martin J
AU - Dhasmana, Devesh J
N1 - Supported by a grant (MC_PC_19056) to the University of Oxford from the Medical Research Council of United Kingdom Research and Innovation and the National Institute for Health Research (NIHR); and by core funding provided by NIHR Oxford Biomedical Research Centre, Wellcome, the Bill and Melinda Gates Foundation, the Department for International Development, Health Data Research UK, the Medical Research Council Population Health Research Unit, the NIHR Health Protection Unit in Emerging and Zoonotic Infections, and NIHR Clinical Trials Unit Support Funding. Dr. Lim is supported by core funding provided by NIHR Nottingham Biomedical Research Centre, Dr. Felton by the NIHR Manchester Biomedical Research Centre, and Dr. Jaki by a grant (MC_UU_0002/14) from the UK Medical Research Council and by an NIHR Senior Research Fellowship (NIHR-SRF-2015-08-001).
PY - 2021/2/25
Y1 - 2021/2/25
N2 - BACKGROUND: Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death.METHODS: In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the final results of this assessment.RESULTS: A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.92 to 1.55).CONCLUSIONS: In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
AB - BACKGROUND: Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Glucocorticoids may modulate inflammation-mediated lung injury and thereby reduce progression to respiratory failure and death.METHODS: In this controlled, open-label trial comparing a range of possible treatments in patients who were hospitalized with Covid-19, we randomly assigned patients to receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Here, we report the final results of this assessment.RESULTS: A total of 2104 patients were assigned to receive dexamethasone and 4321 to receive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and 1110 patients (25.7%) in the usual care group died within 28 days after randomization (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients were receiving at the time of randomization. In the dexamethasone group, the incidence of death was lower than that in the usual care group among patients receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; rate ratio, 1.19; 95% CI, 0.92 to 1.55).CONCLUSIONS: In patients hospitalized with Covid-19, the use of dexamethasone resulted in lower 28-day mortality among those who were receiving either invasive mechanical ventilation or oxygen alone at randomization but not among those receiving no respiratory support.
KW - Administration, oral
KW - Aged
KW - Aged, 80 and over
KW - Anti-Infective agents/therapeutic use
KW - COVID-19/drug therapy
KW - Dexamethasone/administration & dosage
KW - Drug therapy, combination
KW - Female
KW - Glucocorticoids/administration & dosage
KW - Hospitalization
KW - Humans
KW - Injections, intravenous
KW - Kaplan-Meier Estimate
KW - Length of stay
KW - Male
KW - Odds ratio
KW - Oxygen Inhalation Therapy
KW - Respiration, artificial
KW - United Kingdom
U2 - 10.1056/NEJMoa2021436
DO - 10.1056/NEJMoa2021436
M3 - Article
C2 - 32678530
SN - 0028-4793
VL - 384
SP - 693
EP - 704
JO - New England Journal of Medicine
JF - New England Journal of Medicine
IS - 8
ER -