High-Dose Dexamethasone May Be Harmful for Patients With COVID-19

Patients hospitalized with COVID-19 receiving supplemental oxygen had similar mortality outcomes with high- vs standard-dose dexamethasone, but evidence suggests higher dexamethasone doses may be associated with adverse outcomes. These study results were presented at IDWeek 2022, held from October 19 to 23, in Washington, DC.

Anti-inflammatory agents, such as dexamethasone, are standard treatment for COVID-19 infection. Current evidence indicates that a 6mg dose of dexamethasone daily is effective for improving COVID-19 outcomes among patients receiving supplemental oxygen. However, patients are often prescribed higher doses despite a lack of evidence justifying this clinical decision.

To evaluate whether higher doses of dexamethasone may be more effective, researchers conducted a multisite, retrospective, observational study. Included patients were those who were hospitalized with COVID-19 infection and receiving supplemental between June 2020 and January 2022. Patients who received high-dose dexamethasone (>10mg daily; n=159) were matched in a 3:1 fashion with those who received standard-dose dexamethasone (6mg daily; n=53); the researchers compared outcomes between the groups.

No significant differences in the rate of mortality, the number of patients with blood glucose concentrations above 200mg/dL, the rate of nosocomial infections, hospitalization, or the number of ventilator-free days (all P >.05) were observed on the basis of dexamethasone dosing.

Similar results were observed after adjustment for potential confounding factors, with no significant differences observed between the 2 patient groups in regard to the risk for mortality (adjusted odds ratio [aOR], 1.45; 95% CI, 0.66-3.20).

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