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Dexamethasone doses in patients with COVID-19 and hypoxia: A systematic review and meta-analysis
MW. Munch, A. Granholm, J. Maláska, J. Stašek, PO. Rodriguez, T. Pitre, R. Wilson, J. Savović, B. Rochwerg, A. Svobodnik, M. Kratochvíl, M. Taboada, V. Jha, BKT. Vijayaraghavan, SN. Myatra, B. Venkatesh, A. Perner, MH. Møller
Language English Country England, Great Britain
Document type Meta-Analysis, Systematic Review, Journal Article, Review
Grant support
National Institute for Health Research Applied Research Collaboration West
E-22703-06
Rigshospitalet's Research Council
Weston NHS Foundation Trust
Department of Health and Social Care
LM2023049
MEYS LRI CZECRIN
65269705
FNBr
PubMed
37881881
DOI
10.1111/aas.14346
Knihovny.cz E-resources
- MeSH
- COVID-19 * MeSH
- Dexamethasone adverse effects MeSH
- Adult MeSH
- COVID-19 Drug Treatment MeSH
- Hypoxia MeSH
- Humans MeSH
- Patients MeSH
- Check Tag
- Adult MeSH
- Humans MeSH
- Publication type
- Journal Article MeSH
- Meta-Analysis MeSH
- Review MeSH
- Systematic Review MeSH
BACKGROUND: The optimal dose of dexamethasone for severe/critical COVID-19 is uncertain. We compared higher versus standard doses of dexamethasone in adults with COVID-19 and hypoxia. METHODS: We searched PubMed and trial registers until 23 June 2023 for randomised clinical trials comparing higher (>6 mg) versus standard doses (6 mg) of dexamethasone in adults with COVID-19 and hypoxia. The primary outcome was mortality at 1 month. Secondary outcomes were mortality closest to 90 days; days alive without life support; and the occurrence of serious adverse events/reactions (SAEs/SARs) closest to 1 month. We assessed the risk of bias using the Cochrane RoB2 tool, risk of random errors using trial sequential analysis, and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: We included eight trials (2478 participants), of which four (1293 participants) had low risk of bias. Higher doses of dexamethasone probably resulted in little to no difference in mortality at 1 month (relative risk [RR] 0.97, 95% CI: 0.79-1.19), mortality closest to Day 90 (RR 1.01, 95% CI: 0.86-1.20), and SAEs/SARs (RR 1.00, 95% CI: 0.97-1.02). Higher doses of dexamethasone probably increased the number of days alive without invasive mechanical ventilation and circulatory support but had no effect on days alive without renal replacement therapy. CONCLUSIONS: Based on low to moderate certainty evidence, higher versus standard doses of dexamethasone probably result in little to no difference in mortality, SAEs/SARs, and days alive without renal replacement therapy, but probably increase the number of days alive without invasive mechanical ventilation and circulatory support.
2nd Department of Anaesthesiology University Hospital Brno Brno Czech Republic
Collaboration for Research in Intensive Care Copenhagen Denmark
Department of Critical Care Medicine Apollo Hospitals Chennai India
Department of Intensive Care Copenhagen University Hospital Rigshospitalet Copenhagen Denmark
Department of Intensive Care Medicine Wesley Hospital Brisbane Queensland Australia
Department of Medicine McMaster University Hamilton Ontario Canada
Department of Pharmacology CZECRIN Faculty of Medicine Masaryk University Brno Czech Republic
Department of Simulation Medicine Faculty of Medicine Masaryk University Brno Czech Republic
Population Health Sciences Bristol Medical School University of Bristol Bristol England
Prasanna School of Public Health Manipal Academy of Higher Education Manipal India
Pulmonary and Critical Care Medicine Instituto Universitario CEMIC Buenos Aires Argentina
School of Public Health Imperial College London UK
The George Institute for Global Health New Delhi India
The George Institute for Global Health Sydney New South Wales Australia
References provided by Crossref.org
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- $a BACKGROUND: The optimal dose of dexamethasone for severe/critical COVID-19 is uncertain. We compared higher versus standard doses of dexamethasone in adults with COVID-19 and hypoxia. METHODS: We searched PubMed and trial registers until 23 June 2023 for randomised clinical trials comparing higher (>6 mg) versus standard doses (6 mg) of dexamethasone in adults with COVID-19 and hypoxia. The primary outcome was mortality at 1 month. Secondary outcomes were mortality closest to 90 days; days alive without life support; and the occurrence of serious adverse events/reactions (SAEs/SARs) closest to 1 month. We assessed the risk of bias using the Cochrane RoB2 tool, risk of random errors using trial sequential analysis, and certainty of evidence using Grading of Recommendations Assessment, Development and Evaluation (GRADE). RESULTS: We included eight trials (2478 participants), of which four (1293 participants) had low risk of bias. Higher doses of dexamethasone probably resulted in little to no difference in mortality at 1 month (relative risk [RR] 0.97, 95% CI: 0.79-1.19), mortality closest to Day 90 (RR 1.01, 95% CI: 0.86-1.20), and SAEs/SARs (RR 1.00, 95% CI: 0.97-1.02). Higher doses of dexamethasone probably increased the number of days alive without invasive mechanical ventilation and circulatory support but had no effect on days alive without renal replacement therapy. CONCLUSIONS: Based on low to moderate certainty evidence, higher versus standard doses of dexamethasone probably result in little to no difference in mortality, SAEs/SARs, and days alive without renal replacement therapy, but probably increase the number of days alive without invasive mechanical ventilation and circulatory support.
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