Consider Steroids for Some Hospitalized COVID-19 Patients

Questions are flooding in about whether dexamethasone is a "breakthrough" in treating COVID-19.

The buzz is from a U.K. study that suggests dexamethasone reduces mortality in hospitalized patients with severe COVID-19.

This contradicts early guidance to avoid adding steroids for COVID-19...due to lack of benefit and possible harm seen in SARS and MERS.

Consider the study's caveats. It's open-label, and the published data are still preliminary. But it's a large randomized trial...and some COVID-19 guidelines already reflect these results.

These early data suggest adding IV or PO dexamethasone 6 mg/day for up to 10 days in hospitalized patients prevents 1 death for every 8 on mechanical ventilation...or every 34 on supplemental oxygen.

Be aware, steroids don't seem to reduce mortality in patients NOT on oxygen.

There may be a sweet spot for steroids in COVID-19...treating the right patient at the right time with the right dose.

The theory is EARLY steroid use may hinder the immune system's ability to fight the virus. But low-dose steroids LATER in the illness seem to help...as symptoms progress and inflammation ramps up.

Consider dexamethasone 6 mg/day for COVID-19 hospitalized patients requiring mechanical ventilation or oxygen.

Convert to oral dexamethasone when possible...since injectable shortages are occurring. And consider drawing up the IV 6 mg dose in the pharmacy...to reduce waste.

Be ready to manage side effects of short-term steroid use...delirium, hyperglycemia, etc.

Stop dexamethasone at 10 days...or at discharge if that's sooner. Keep in mind, a taper isn't needed with this short course.

Use our chart, COVID-19 and Pharmacotherapy, for advice about remdesivir, convalescent plasma, and more. Access our COVID-19 Resource Hub for articles, charts, and other tools.

Key References

  • N Engl J Med Published online Jul 17, 2020; doi:10.1056/NEJMoa2021436
  • N Engl J Med Published online Jul 17, 2020; doi:10.1056/NEJMe2024638
  • www.idsociety.org/practice-guideline/covid-19-guideline-treatment-and-management/ (7-29-20)
  • www.covid19treatmentguidelines.nih.gov/ (7-29-20)
Hospital Pharmacist's Letter. August 2020, No. 360802



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