Comparison of Standard and Extended Dexamethasone Duration on Mortality in Patients with Severe COVID-19.

Objectives: Current guidelines recommend dexamethasone 6 mg/day for up to 10 days in patients with severe coronavirus disease 2019 (COVID-19) requiring supplemental oxygenation or mechanical ventilation. The practice has significant variation, however, and dexamethasone has been used for >10 days for many patients with severe COVID-19. The aim of this study was to assess the benefits and risks associated with standard versus extended use of dexamethasone in patients with severe COVID-19.

Methods: A multicenter retrospective cohort study was conducted from January 2021 to December 2021. All of the consecutive patients with severe COVID-19 receiving 6 mg/day dexamethasone were eligible for inclusion. The primary outcome was the incidence of in-hospital mortality for patients treated with dexamethasone 6 mg/day for the standard duration of 10 days versus an extended duration of >10 days.

Results: A total of 1294 patients met the inclusion criteria: 803 received the standard duration of dexamethasone and 491 received the extended duration. The incidence of in-hospital mortality was significantly higher (P = 0.003) in the extended duration group (36.5%) compared with the standard duration group (28.5%), with no significant difference in in-hospital major adverse cardiac events (16.1% for extended vs 13.2% for the standard duration; P = 0.15).

Conclusions: The results show that extended duration of dexamethasone compared with standard duration is associated with a significant increase in in-hospital mortality in patients with severe COVID-19. These findings need to be confirmed in well-designed and performed randomized controlled trials.