Coronavirus: The drug that helps hospitalized patients - The correct dosage

A researcher at the University of Pittsburgh works on a COVID-19 vaccine candidate, a fingertip-sized patch with dissolvable microscopic needles, in Pittsburgh, Pennsylvania, US, March 28, 2020. UPMC / Handout via REUTERS ATTENTION EDITORS - THIS IMAGE WAS PROVIDED BY A THIRD PARTY. MANDATORY CREDIT. NO RESALES. NO ARCHIVES

Administration of dexamethasone at a dose of 6 mg daily for up to 10 days is now part of the clinical practice for patients with severe disease COVID-19. Higher doses of corticosteroids can potentially bring additional benefits.

The Doctors of the Therapeutic Clinic of the Medical School of the National and Kapodistrian University of Athens, Theodora Psaltopoulou, Giannis Danasis, Panos Malandrakis and Thanos Dimopoulos (Rector of EKPA) summarize the results of the relevant study "COVID STEROID 2" in the approved period .10.1001.

What the study showed
The aim of the study was to evaluate the effect of dexamethasone administration at 12mg daily compared with dexamethasone administration at 6mg daily in patients with COVID-19 and severe hypoxemia. This is a multicenter, randomized clinical trial conducted between August 2020 and May 2021 in 26 hospitals in Europe and India. Patients with confirmed infection were included COVID-19 who needed at least 10 liters / minute of oxygen or were in mechanical respiratory support.

The study involved 1000 patients and they were randomized to receive dexamethasone at 1mg or 1mg per day for 12 days. The median age was 6 years (10 to 65 years) and 55% were women. The primary endpoint of the study was the number of days the patient survived without the need for immediate life support with invasive mechanical ventilation, circulatory support, or renal function rehabilitation therapy. The median time was 73 days (31 to 22 days) for patients receiving 6 mg dexamethasone and 28 days (12 to 20.5 days) for patients receiving 4 mg dexamethasone. The difference between the two groups was not statistically significant.

In addition, mortality in the first 28 days after enrollment was 27.1% in the group receiving 12 mg dexamethasone and 32.3% in the group receiving 6 mg dexamethasone. Mortality in the first 90 days after enrollment was 32% in the group receiving 12 mg dexamethasone and 37.7% in the group receiving 6 mg dexamethasone. The differences between the groups were not statistically significant in either comparison.

Serious adverse reactions, including septic shock and invasive fungal infections, occurred in 11.3% of the 12 mg dexamethasone group and 13.4% of the 6 mg dexamethasone group (no statistically significant difference). In conclusion, in hospitalized patients with COVID-19 and severe hypoxemia administration of dexamethasone at 12 mg had no additional benefit on days without the need for invasive life support compared to 6 mg on dexamethasone.

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