Full 10 days Dexamethasone prescription in COVID-19 patients fails to improve outcomes

Current guidelines recommend the use of dexamethasone, 6 mg/d, up to 10 days or until discharge for patients hospitalized with COVID-19. Whether patients who received less than 10 days of corticosteroids during hospitalization for COVID-19 benefit from continuing treatment at discharge has not been determined.

A study was conducted to assess whether continuing dexamethasone treatment at discharge is associated with reduced all-cause readmissions or mortality post-discharge.

A retrospective cohort study was conducted at 15 medical centres within Kaiser Permanente Southern California. The population included adults who received less than 10 days of dexamethasone, 6 mg/d, until discharge during hospitalization for COVID-19 and were discharged alive between May 1 and September 30, 2020.

Results:

A total of 1164 patients with a median age of 55 (IQR, 44-66) years were identified. Most patients were of Hispanic ethnicity (822 [70.6%]) and male (674 [57.9%]) and required oxygen support during hospitalization (1048 [90.0%]). Of the 1164 patients, 692 (59.5%) continued dexamethasone, 6 mg/d, at discharge. A balanced cohort was created using propensity score and inverse probability of treatment weighting. The adjusted odds ratio (OR) for readmissions or mortality within 14 days was 0.87 (95% CI, 0.58-1.30) for patients who continued dexamethasone therapy at discharge compared with those who did not. Similar results were produced by a sensitivity analysis that restricted the treatment group to those who received exactly 10 days of dexamethasone (OR, 0.89; 95% CI, 0.55-1.43) and by subgroup analyses stratified by the duration of dexamethasone treatment as an inpatient (1-3 days: OR, 0.71; 95% CI, 0.43-1.16; 4-9 days: OR, 1.01; 95% CI, 0.48-2.12), oxygen requirement at discharge (room air: OR, 0.91; 95% CI, 0.53-1.59; supplemental oxygen use: OR, 0.76; 95% CI, 0.42-1.37), and disease duration at discharge (≤10 days: OR, 0.81; 95% CI, 0.49-1.33; >10 days: OR, 0.94; 95% CI, 0.48-1.86).

Thus, in this cohort study of patients with COVID-19, continuing treatment with dexamethasone, 6 mg/d, at discharge was not associated with a reduction in 14-day all-cause readmission or mortality. This finding suggests that dexamethasone should not be routinely prescribed beyond discharge for individuals with COVID-19.

Reference:

Association Between Dexamethasone Treatment After Hospital Discharge for Patients With COVID-19 Infection and Rates of Hospital Readmission and Mortality by Cheng-Wei Huang, et al. published in the JAMA.

https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2789710?utm_source=For_The_Media&utm_medium=referral&utm_campaign=ftm_links&utm_term=030822

Keywords:

Cheng-Wei Huang, Albert S. Yu, Hubert Song, Joon S. Park, Stefanie S. Wu, Vang Kou Khang, Christopher C. Subject, Ernest Shen, Dexamethasone and covid-19, Hospital Readmission and covid-19, Hospital Readmission and Mortality in covid-19, Dexamethasone and Covid-19, JAMA Network open.