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
RCT (n=299) found that number of days alive and free from mechanical ventilation during first 28 days was significantly higher among patients treated with dexamethasone plus standard care vs. standard care alone (6.6 days vs 4.0 days; p = 0.04).
Source:
Journal of the American Medical Association
SPS commentary:
This trial was published in JAMA along with 2 other randomised trials of corticosteroids and a meta-analysis:
According to an editorial, these data represent an important step forward in the treatment of patients with COVID-19. It notes that while the RECOVERY results were embraced because they provided hope in the treatment of this catastrophic disease, numerous study limitations prevented complete confidence in using corticosteroids in hospitalized patients with COVID-19. It adds that these trials and the meta-analysis have strengthened confidence, further defined the benefit, and shifted usual care of COVID-19–related acute respiratory distress syndrome. (ARDS) to include corticosteroids.
It warns however that many clinically important questions remain.
While much work remains on the exact details of implementation into clinical practice, it concludes for now that the consistent findings of benefit in these studies provide definitive data that corticosteroids should be first-line treatment for critically ill patients with COVID-19.
Following publication of the REMAP-CAP trial and this meta-analysis, the World Health Organization has issued new interim guidance recommending the use of systemic corticosteroids in severe and critical COVID-19 disease as follows: