9/2/2023 0 Comments Matt couch lazarus brewing![]() Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX Randomized Clinical Trial. Tomazini BM, Maia IS, Cavalcanti AB, et al. RECOVERY Collaborative Group Baricitinib in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial and updated meta-analysis. RECOVERY Collaborative Group Tocilizumab in patients admitted to hospital with COVID-19 (RECOVERY): a randomised, controlled, open-label, platform trial. Dexamethasone in hospitalized patients with COVID-19. This is an Open Access article under the CC BY 4.0 license. UK Research and Innovation (Medical Research Council), National Institute of Health and Care Research, and Wellcome Trust.Ĭopyright © 2023 The Author(s). The RECOVERY trial continues to assess the effects of higher dose corticosteroids in patients hospitalised with COVID-19 who require non-invasive ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation. ![]() In patients hospitalised for COVID-19 with clinical hypoxia who required either no oxygen or simple oxygen only, higher dose corticosteroids significantly increased the risk of death compared with usual care, which included low-dose corticosteroids. There was also an excess of pneumonia reported to be due to non-COVID infection (64 cases vs 37 cases absolute difference 3♷% ) and an increase in hyperglycaemia requiring increased insulin dose (142 vs 87 absolute difference 7♴% ). 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 (rate ratio 1♵9 p=0♰012). Of those randomly assigned, 745 (59%) were in Asia, 512 (40%) in the UK, and 15 (1%) in Africa. The RECOVERY trial is registered with ISRCTN (50189673) and ( NCT04381936).īetween May 25, 2021, and May 13, 2022, 1272 patients with COVID-19 and hypoxia receiving no oxygen (eight ) or simple oxygen only (1264 ) were randomly allocated to receive usual care plus higher dose corticosteroids (659 patients) versus usual care alone (613 patients, of whom 87% received low-dose corticosteroids during the follow-up period). Recruitment of patients receiving ventilatory support is ongoing. We report the results for these participants only. On May 11, 2022, the independent data monitoring committee recommended stopping recruitment of patients receiving no oxygen or simple oxygen only due to safety concerns. The primary outcome was 28-day mortality among all randomised participants. Eligible and consenting adult patients with clinical evidence of hypoxia (ie, receiving oxygen or with oxygen saturation <92% on 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 6 mg once daily for 10 days or until discharge if sooner). This randomised, controlled, open-label platform trial (Randomised Evaluation of COVID-19 Therapy ) is assessing multiple possible treatments in patients hospitalised for COVID-19. ![]() We evaluated the use of a higher dose of corticosteroids in this patient group. Low-dose corticosteroids have been shown to reduce mortality for patients with COVID-19 requiring oxygen or ventilatory support (non-invasive mechanical ventilation, invasive mechanical ventilation, or extracorporeal membrane oxygenation). ![]()
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