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Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom

A clinical interpretation of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) study was performed to provide a useful tool to understand whether, when, and to whom dexamethasone should be administered during hospitalization for COVID-19. A post hoc analysis of data published in the prelimina...

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Autores principales: Calzetta, Luigino, Aiello, Marina, Frizzelli, Annalisa, Rogliani, Paola, Chetta, Alfredo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069656/
https://www.ncbi.nlm.nih.gov/pubmed/33920093
http://dx.doi.org/10.3390/jcm10081607
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author Calzetta, Luigino
Aiello, Marina
Frizzelli, Annalisa
Rogliani, Paola
Chetta, Alfredo
author_facet Calzetta, Luigino
Aiello, Marina
Frizzelli, Annalisa
Rogliani, Paola
Chetta, Alfredo
author_sort Calzetta, Luigino
collection PubMed
description A clinical interpretation of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) study was performed to provide a useful tool to understand whether, when, and to whom dexamethasone should be administered during hospitalization for COVID-19. A post hoc analysis of data published in the preliminary report of the RECOVERY study was performed to calculate the person-based number needed to treat (NNT) and number needed to harm (NNH) of 6 mg dexamethasone once daily for up to 10 days vs. usual care with respect to mortality. At day 28, the NNT of dexamethasone vs. usual care was 36.0 (95%CI 24.9–65.1, p < 0.05) in all patients, 8.3 (95%CI 6.0–13.1, p < 0.05) in patients receiving invasive mechanical ventilation, and 34.6 (95%CI 22.1–79.0, p < 0.05) in patients receiving oxygen only (with or without noninvasive ventilation). Dexamethasone increased mortality compared with usual care in patients not requiring oxygen supplementation, leading to a NNH value of 26.7 (95%CI 18.1–50.9, p < 0.05). NNT of dexamethasone vs. usual care was 17.3 (95%CI 14.9–20.6) in subjects <70 years, 27.0 (95%CI 18.5–49.8) in men, and 16.2 (95%CI 13.2–20.8) in patients in which the onset of symptoms was >7 days. Dexamethasone is effective in male subjects < 70 years that require invasive mechanical ventilation experiencing symptoms from >7 days and those patients receiving oxygen without invasive mechanical ventilation; it should be avoided in patients not requiring respiratory support.
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spelling pubmed-80696562021-04-26 Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom Calzetta, Luigino Aiello, Marina Frizzelli, Annalisa Rogliani, Paola Chetta, Alfredo J Clin Med Brief Report A clinical interpretation of the Randomized Evaluation of COVID-19 Therapy (RECOVERY) study was performed to provide a useful tool to understand whether, when, and to whom dexamethasone should be administered during hospitalization for COVID-19. A post hoc analysis of data published in the preliminary report of the RECOVERY study was performed to calculate the person-based number needed to treat (NNT) and number needed to harm (NNH) of 6 mg dexamethasone once daily for up to 10 days vs. usual care with respect to mortality. At day 28, the NNT of dexamethasone vs. usual care was 36.0 (95%CI 24.9–65.1, p < 0.05) in all patients, 8.3 (95%CI 6.0–13.1, p < 0.05) in patients receiving invasive mechanical ventilation, and 34.6 (95%CI 22.1–79.0, p < 0.05) in patients receiving oxygen only (with or without noninvasive ventilation). Dexamethasone increased mortality compared with usual care in patients not requiring oxygen supplementation, leading to a NNH value of 26.7 (95%CI 18.1–50.9, p < 0.05). NNT of dexamethasone vs. usual care was 17.3 (95%CI 14.9–20.6) in subjects <70 years, 27.0 (95%CI 18.5–49.8) in men, and 16.2 (95%CI 13.2–20.8) in patients in which the onset of symptoms was >7 days. Dexamethasone is effective in male subjects < 70 years that require invasive mechanical ventilation experiencing symptoms from >7 days and those patients receiving oxygen without invasive mechanical ventilation; it should be avoided in patients not requiring respiratory support. MDPI 2021-04-10 /pmc/articles/PMC8069656/ /pubmed/33920093 http://dx.doi.org/10.3390/jcm10081607 Text en © 2021 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Brief Report
Calzetta, Luigino
Aiello, Marina
Frizzelli, Annalisa
Rogliani, Paola
Chetta, Alfredo
Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom
title Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom
title_full Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom
title_fullStr Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom
title_full_unstemmed Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom
title_short Dexamethasone in Patients Hospitalized with COVID-19: Whether, When and to Whom
title_sort dexamethasone in patients hospitalized with covid-19: whether, when and to whom
topic Brief Report
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8069656/
https://www.ncbi.nlm.nih.gov/pubmed/33920093
http://dx.doi.org/10.3390/jcm10081607
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