Higher-dose corticosteroids linked to increased risk of death in some hypoxic COVID-19 patients

Medical Xpress / European Cong of Clinical Microbiology & Infectious Dis (ECCMID 2023) / The Lancet ^ | April 12, 2023 | Prof Sir Peter Horby et al

[ConservativeMind]

A study shows that compared with standard care that included low-dose corticosteroid use, treating hypoxic COVID-19 patients needing only oxygen therapy or no breathing support with higher-dose corticosteroids is associated with a 60% increased risk of death.

This study had already identified that low-dose corticosteroids reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support. However, in May 2022, the independent Data Monitoring Committee advised that this treatment assessment be stopped for those patients receiving oxygen alone or no breathing support.

Eligible and consenting adult patients with COVID-19 and clinical evidence of hypoxia (i.e., receiving oxygen or with oxygen saturation <92% in normal room air) were randomly allocated (1:1) to either usual care with higher-dose corticosteroids (dexamethasone 20 mg once daily for 5 days followed by 10 mg dexamethasone once daily for 5 days or until discharge if sooner) or usual standard of care alone (which included dexamethasone at the lower 6 mg, once-daily dose for 10 days or until discharge if sooner). The primary outcome was 28-day mortality among all randomised participants.

Overall, 123 (19%) of 659 patients allocated to higher-dose corticosteroids versus 75 (12%) of 613 patients allocated to usual care died within 28 days—meaning a 60% increased risk of mortality for the higher dose corticosteroid group.

There was also an excess of pneumonia reported to be due to non-COVID infection in the higher-dose corticosteroid group: 64 cases (10%) vs. 37 cases (6%); and an increase in hyperglycemia (high blood sugar episode) requiring an increased insulin dose: 142 [22%] vs. 87 [14%].

The authors conclude, "Among hospitalized patients with COVID-19 who require oxygen or ventilatory support, low-dose corticosteroids reduce the risk of death. However, among patients requiring simple oxygen only, higher doses of corticosteroids increase the risk of death compared with low-dose corticosteroids."

[ConservativeMind]

Dexamethasone at 6 mg was best. Dexamethasone at 20 mg, then 10 mg, killed 60% more people.

[ConservativeMind]

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[Seaplaner]

I avoid corticosteroids, too many undesirable side effects.

If I need to reduce inflammation, I rely on higher dose fish oils and a few other natural supplements.

(I'm not a physician, so this is not a recommendation.)