Study finds dexamethasone may be underused in patients with severe COVID-19

Hospitalized patient receives oxygen through mask while attended by clinicians.

As many as one-fifth of patients hospitalized with severe COVID-19 nationwide who may have benefited from treatment with the anti-inflammatory dexamethasone were not given this treatment during the height of the pandemic, according to a large, retrospective U.S. study. Dexamethasone is now a standard weapon against severe COVID and appears to significantly lower the risk of dying from the disease in patients on mechanical ventilators. 

For the study, researchers analyzed the health records of 137,870 people hospitalized in the United States with suspected or confirmed COVID-19 for the 13-month period from February 2020 through February 2021. They characterized the use of dexamethasone, the antiviral drug remdesivir, and hydroxychloroquine for the treatment of COVID-19 among 43 health systems across the United States. 
Of the patients treated, 6.3% received hydroxychloroquine, 21.2% received remdesivir, and 39.1% received dexamethasone. The use of remdesivir and dexamethasone slowly increased over the study period, while the use of hydroxychloroquine rose and the fell sharply following reports that it was ineffective. The use of dexamethasone and remdesivir varied widely across health centers during the study period. 
The researchers found that about 20% of patients who might have benefit from dexamethasone did not receive the drug.  The results also suggest that a uniform set of standards for dexamethasone use among COVID-patients may be needed. The study, funded in part by the NHLBI, appeared in the Annals of Internal Medicine.