Dexamethasone in Hospitalized Patients with Covid-19 (RECOVERY)
AI-Generated Summary
Educational summary — always verify with primary sourceEarly in the COVID-19 pandemic, corticosteroids were controversial — some guidelines recommended against them based on prior SARS/MERS data. RECOVERY was a large adaptive platform trial that tested multiple interventions.
Multicenter RCT (176 UK hospitals, n=6,425) comparing dexamethasone 6 mg/day for 10 days vs. usual care in hospitalized COVID-19 patients.
Dexamethasone reduced 28-day mortality in patients requiring mechanical ventilation (29.3% vs 41.4%, RR 0.64) and those requiring oxygen only (23.3% vs 26.2%, RR 0.82). No benefit — and possible harm — in patients not requiring oxygen (17.8% vs 14.0%).
Dexamethasone 6 mg/day for 10 days is standard of care for COVID-19 patients requiring supplemental oxygen or mechanical ventilation. Do NOT use in patients not requiring oxygen. This is the single most impactful COVID-19 treatment trial.
Open-label design. Conducted during early pandemic when treatment protocols were evolving. The benefit is specific to patients requiring respiratory support.
Know the three groups: ventilated (benefit), oxygen only (benefit), no oxygen (no benefit/possible harm). This is a high-yield board question.
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