Consider Corticosteroids for Hospitalized COVID-19 Patients Needing Oxygen

Posted July 21, 2020: Article in Progress. We’re releasing this article ahead of our August 2020 issue to quickly provide information to our readers. The information contained in this version is based on the best evidence available to us as of the date of posting. The final version may include revised recommendations.

Questions are flooding in about whether dexamethasone is a “breakthrough” in treating COVID-19.

The buzz is due to a U.K. study suggesting that dexamethasone reduces mortality in hospitalized patients with severe COVID-19.

This contradicts early guidance to avoid adding steroids for COVID-19...due to lack of benefit and possible harm seen in SARS.

Consider study caveats. It’s a large randomized trial...but it’s open-label. And published data are still preliminary...but some COVID-19 guidelines include these results.

These early data suggest adding IV or PO dexamethasone 6 mg/day for up to 10 days prevents 1 death for every 8 hospitalized patients on mechanical ventilation...or every 34 on supplemental oxygen.

But there doesn’t seem to be a benefit in patients NOT on oxygen.

Timing may matter. The theory is that early steroid use may reduce the immune system’s ability to fight the virus.

But steroid use seems to be beneficial as symptoms progress...and inflammation ramps up.

Be aware, results may be muddied by use of other treatments.

And the study doesn’t report adverse effects. Short-term steroid use can cause hyperglycemia, delirium, etc.

Consider dexamethasone for hospitalized patients requiring mechanical ventilation or oxygen.

Convert to oral dexamethasone when possible...shortages of dexamethasone injection are popping up. If necessary, consider a roughly equivalent alternative, such as methylprednisolone 40 mg.

Stop dexamethasone at 10 days...or at discharge if that’s sooner. Keep in mind, a taper isn’t needed with this short course.

Don’t use dexamethasone or other steroids...including inhaled treat OR prevent COVID-19 in the community.