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02.06.2023 | Short Communication

Intermediate- to high-dose dexamethasone versus low-dose dexamethasone in patients with COVID-19 requiring respiratory support: a systematic review and meta-analysis of randomized trials

verfasst von: Chia Siang Kow, Dinesh Sangarran Ramachandram, Syed Shahzad Hasan

Erschienen in: Inflammopharmacology | Ausgabe 5/2023

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Abstract

The present review critically appraised the randomized clinical trials that compared mortality outcomes between intermediate- to high-dose dexamethasone and low-dose dexamethasonein patients with COVID-19 and reported pooled mortality risk estimates associated with these two dosing regimens of dexamethasone. The systematic searching of electronic databases was limited to randomized clinical trials that compared mortality outcomes between intermediate- to high-dose dexamethasone with low-dose dexamethasone in patients with COVID-19 requiring respiratory support. The primary outcome of interest in this review was all-cause mortality. A total of eight trials with 1800 patients randomized to receive intermediate to high-dose dexamethasone and 1715 patients randomized to low-dose dexamethasone were included. The meta-analysis of six trials revealed no significant difference in the risk of 28-day all-cause mortality between intermediate- to high-dose dexamethasone and low-dose dexamethasone (odds ratio 1.16, 95% confidence interval, 0.77–1.74). Similarly, the meta-analysis of five trials revealed no significant difference between the two doses regarding 60-day all-cause mortality (odds ratio 0.96, 95% confidence interval 0.74–1.26). The results suggest intermediate- to high-dose dexamethasone to be as effective as low-dose dexamethasone in reducing the risk of mortality among patients with COVID-19 requiring respiratory support. However, higher dexamethasone doses could expose patients with COVID-19 to an increased risk of adverse events, such as hyperglycemia.
Literatur
Zurück zum Zitat Abani O, Abbas A, Abbas F, Abbas J, Abbas K, Abbas M, Abbasi S, Abbass H, Abbott A, Abbott A, Abdallah N (2022) Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis. The Lancet 400(10349):359–368CrossRef Abani O, Abbas A, Abbas F, Abbas J, Abbas K, Abbas M, Abbasi S, Abbass H, Abbott A, Abbott A, Abdallah N (2022) Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis. The Lancet 400(10349):359–368CrossRef
Zurück zum Zitat Bouadma L, Mekontso-Dessap A, Burdet C, Merdji H, Poissy J, Dupuis C, Guitton C, Schwebel C, Cohen Y, Bruel C, Marzouk M (2022) High-dose dexamethasone and oxygen support strategies in intensive care unit patients with severe COVID-19 acute hypoxemic respiratory failure: the COVIDICUS randomized clinical trial. JAMA Intern Med 182(9):906–916CrossRefPubMedPubMedCentral Bouadma L, Mekontso-Dessap A, Burdet C, Merdji H, Poissy J, Dupuis C, Guitton C, Schwebel C, Cohen Y, Bruel C, Marzouk M (2022) High-dose dexamethasone and oxygen support strategies in intensive care unit patients with severe COVID-19 acute hypoxemic respiratory failure: the COVIDICUS randomized clinical trial. JAMA Intern Med 182(9):906–916CrossRefPubMedPubMedCentral
Zurück zum Zitat Domingo P, Mur I, Mateo GM, del Mar GM, Pomar V, de Benito N, Corbacho N, Herrera S, Millan L, Muñoz J, Malouf J (2021) Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19: a meta-analysis. JAMA 326(6):499–518CrossRefPubMed Domingo P, Mur I, Mateo GM, del Mar GM, Pomar V, de Benito N, Corbacho N, Herrera S, Millan L, Muñoz J, Malouf J (2021) Association between administration of IL-6 antagonists and mortality among patients hospitalized for COVID-19: a meta-analysis. JAMA 326(6):499–518CrossRefPubMed
Zurück zum Zitat Granholm A, Kjær MB, Munch MW, Myatra SN, Vijayaraghavan BK, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Vesterlund GK, Meyhoff TS (2022) Long-term outcomes of dexamethasone 12 mg versus 6 mg in patients with COVID-19 and severe hypoxaemia. Intensive Care Med 48(5):580–589CrossRefPubMedPubMedCentral Granholm A, Kjær MB, Munch MW, Myatra SN, Vijayaraghavan BK, Cronhjort M, Wahlin RR, Jakob SM, Cioccari L, Vesterlund GK, Meyhoff TS (2022) Long-term outcomes of dexamethasone 12 mg versus 6 mg in patients with COVID-19 and severe hypoxaemia. Intensive Care Med 48(5):580–589CrossRefPubMedPubMedCentral
Zurück zum Zitat Kow CS, Hasan SS (2021) Corticosteroid-related in-hospital hyperglycemia: does it negate mortality benefits in coronavirus disease 2019? Clin Infect Dis 73(9):e2848–e2849CrossRefPubMed Kow CS, Hasan SS (2021) Corticosteroid-related in-hospital hyperglycemia: does it negate mortality benefits in coronavirus disease 2019? Clin Infect Dis 73(9):e2848–e2849CrossRefPubMed
Zurück zum Zitat Maskin LP, Bonelli I, Olarte GL, Palizas F Jr, Velo AE, Lurbet MF, Lovazzano P, Kotsias S, Attie S, Lopez Saubidet I, Baredes ND (2022) High-versus low-dose dexamethasone for the treatment of COVID-19-related acute respiratory distress syndrome: a multicenter, randomized open-label clinical trial. J Intensive Care Med 37(4):491–499CrossRefPubMedPubMedCentral Maskin LP, Bonelli I, Olarte GL, Palizas F Jr, Velo AE, Lurbet MF, Lovazzano P, Kotsias S, Attie S, Lopez Saubidet I, Baredes ND (2022) High-versus low-dose dexamethasone for the treatment of COVID-19-related acute respiratory distress syndrome: a multicenter, randomized open-label clinical trial. J Intensive Care Med 37(4):491–499CrossRefPubMedPubMedCentral
Zurück zum Zitat Munch MW, Myatra SN, Vijayaraghavan BK, Saseedharan S, Benfield T, Wahlin RR, Rasmussen BS, Andreasen AS, Poulsen LM, Cioccari L, Khan MS, COVID STEROID 2 Trial Group (2021) Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: the COVID STEROID 2 randomized trial. JAMA 326(18):1PubMedCentral Munch MW, Myatra SN, Vijayaraghavan BK, Saseedharan S, Benfield T, Wahlin RR, Rasmussen BS, Andreasen AS, Poulsen LM, Cioccari L, Khan MS, COVID STEROID 2 Trial Group (2021) Effect of 12 mg vs 6 mg of dexamethasone on the number of days alive without life support in adults with COVID-19 and severe hypoxemia: the COVID STEROID 2 randomized trial. JAMA 326(18):1PubMedCentral
Zurück zum Zitat RECOVERY Collaborative Group (2021) Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 384(8):693–704CrossRef RECOVERY Collaborative Group (2021) Dexamethasone in hospitalized patients with Covid-19. N Engl J Med 384(8):693–704CrossRef
Zurück zum Zitat RECOVERY Collaborative Group (2023) Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet 401(10387):1499–1507 RECOVERY Collaborative Group (2023) Higher dose corticosteroids in patients admitted to hospital with COVID-19 who are hypoxic but not requiring ventilatory support (RECOVERY): a randomised, controlled, open-label, platform trial. Lancet 401(10387):1499–1507
Zurück zum Zitat Taboada M, Rodríguez N, Varela PM, Rodríguez MT, Abelleira R, González A, Casal A, Peromingo JA, Lama A, Domínguez MJ, Rábade C (2022) Effect of high versus low dose of dexamethasone on clinical worsening in patients hospitalised with moderate or severe COVID-19 pneumonia: an open-label, randomised clinical trial. Europ Respirat J 60(2):2102518CrossRef Taboada M, Rodríguez N, Varela PM, Rodríguez MT, Abelleira R, González A, Casal A, Peromingo JA, Lama A, Domínguez MJ, Rábade C (2022) Effect of high versus low dose of dexamethasone on clinical worsening in patients hospitalised with moderate or severe COVID-19 pneumonia: an open-label, randomised clinical trial. Europ Respirat J 60(2):2102518CrossRef
Zurück zum Zitat Toroghi N, Abbasian L, Nourian A, Davoudi-Monfared E, Khalili H, Hasannezhad M, Ghiasvand F, Jafari S, Emadi-Kouchak H, Yekaninejad MS (2022) Comparing efficacy and safety of different doses of dexamethasone in the treatment of COVID-19: a three-arm randomized clinical trial. Pharmacol Rep. https://doi.org/10.1007/s43440-021-00341-0CrossRefPubMed Toroghi N, Abbasian L, Nourian A, Davoudi-Monfared E, Khalili H, Hasannezhad M, Ghiasvand F, Jafari S, Emadi-Kouchak H, Yekaninejad MS (2022) Comparing efficacy and safety of different doses of dexamethasone in the treatment of COVID-19: a three-arm randomized clinical trial. Pharmacol Rep. https://​doi.​org/​10.​1007/​s43440-021-00341-0CrossRefPubMed
Zurück zum Zitat Wu H, Daouk S, Kebbe J, Chaudry F, Harper J, Brown B (2022) Low-dose versus high-dose dexamethasone for hospitalized patients with COVID-19 pneumonia: A randomized clinical trial. PLoS ONE 17(10):e0275217CrossRefPubMedPubMedCentral Wu H, Daouk S, Kebbe J, Chaudry F, Harper J, Brown B (2022) Low-dose versus high-dose dexamethasone for hospitalized patients with COVID-19 pneumonia: A randomized clinical trial. PLoS ONE 17(10):e0275217CrossRefPubMedPubMedCentral
Metadaten
Titel
Intermediate- to high-dose dexamethasone versus low-dose dexamethasone in patients with COVID-19 requiring respiratory support: a systematic review and meta-analysis of randomized trials
verfasst von
Chia Siang Kow
Dinesh Sangarran Ramachandram
Syed Shahzad Hasan
Publikationsdatum
02.06.2023
Verlag
Springer International Publishing
Erschienen in
Inflammopharmacology / Ausgabe 5/2023
Print ISSN: 0925-4692
Elektronische ISSN: 1568-5608
DOI
https://doi.org/10.1007/s10787-023-01251-8