Year: 2020
Type: article
Study design: Clinical Trial
Abstract: 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. (Funded by the Medical Research Council and National Institute for Health Research and others; RECOVERY ClinicalTrials.gov number, NCT04381936; ISRCTN number, 50189673.).
Source: New England Journal of Medicine
Authors: Peter Horby, Wei Shen Lim, Jonathan Emberson, Marion Mafham, Jennifer Bell, Louise Linsell, Natalie Staplin, Christopher Brightling, Andrew Ustianowski, Einas Elmahi, Benjamin Prudon, Christopher Green, Timothy Felton, David Chadwick, Kanchan Rege, Christopher Fegan, Lucy C Chappell, Saul N Faust, Thomas Jaki, Katie Jeffery, Alan Montgomery, Kathryn Rowan, Edmund Juszczak, J Kenneth Baillie, Richard Haynes, Martin J Landray, RECOVERY Collaborative Group
Institutions: University of Oxford, Nottingham University Hospitals NHS Trust, MRC Population Health Research Unit, University of Leicester, NIHR Leicester Biomedical Research Centre, North Manchester General Hospital, University of Manchester, Northampton General Hospital, Northampton General Hospital NHS Trust, North Tees and Hartlepool NHS Foundation Trust, University Hospitals Birmingham NHS Foundation Trust, University of Birmingham, Manchester University NHS Foundation Trust, James Cook University Hospital, Cardiff and Vale University Health Board, King's College London, University Hospital Southampton NHS Foundation Trust, NIHR Southampton Biomedical Research Centre, University of Southampton, University of Cambridge, MRC Biostatistics Unit, Lancaster University, Oxford University Hospitals NHS Trust, University of Nottingham, Intensive Care National Audit & Research Centre, Roslin Institute, University of Edinburgh
Language: English
Subfield: Infectious Diseases
Field: Medicine
Domain: Health Sciences
Open Access status: green
Funders: Bill and Melinda Gates Foundation, Wellcome Trust, UK Research and Innovation, Cancer Research UK, National Institute for Health and Care Research, Department of Health and Social Care, Kidney Research UK, Academy of Medical Sciences, University of Oxford, Public Health England, Department for International Development, Medical Research Council, Biotechnology and Biological Sciences Research Council, NIHR Oxford Biomedical Research Centre, NIHR Nottingham Biomedical Research Centre, Health Data Research UK, NIHR Academy
Awards: G120503279, G1209219644, Accelerating the Elimination of Hepatitis C in the UK, G1670097818, G1823651266, G1991282833, NIHR Senior Investigator Award, NIHR Senior Investigator Award, Double-blinded randomised controlled trial of early low dose steroids in patients admitted to hospital with influenza infection during a pandemic, Understanding the SARS-CoV2 virus and the pathogenesis and transmission of COVID-19., G3276968844, G450193648, G4607536318, G4765384873, NIHR Senior Investigator Award, G5127727671, G5449738238, G5451637898, G5890733345, Improving maternal and perinatal outcomes in high-risk pregnancies, G6538311282, Improving treatment for patients by design, The clinical and cost-effectiveness of contemporary diagnostics for patients with suspected Hospital-Acquired Pneumonia (HAP)., G7066232665, Host responses underlying immunity, G7201224627, G7219336924, G7308200478, G7450368216, G7496083528, G7606040908, RECOVERY International, G7753243063, G7843412646, G8381483046
OpenAlex ID: W3042270788