High-dose dexamethasone treatment for COVID-19 severe acute respiratory distress syndrome: a retrospective study

Abstract

Low-dose dexamethasone reduces mortality in patients with coronavirus disease 2019 (COVID-19)-related acute respiratory distress syndrome (ARDS). We retrospectively analyzed the efficacy of high-dose dexamethasone in patients with COVID-19-related ARDS and evaluated factors affecting the composite outcome (death or invasive mechanical ventilation). From March 4th to April 1st 2020, 98 patients with COVID-19 pneumonia were included. Those who after at least 7 days from symptom onset presented a worsening of the respiratory function or of inflammatory biomarkers were started on intravenous high-dose dexamethasone (20 mg daily for 5 days, followed by 10 mg daily for 5 days). Most patients were males (62%) with a mean age of 69 years. Hypertension and cardiovascular disease (CVD) were prevalent. Following dexamethasone treatment, a significant improvement in PaO 2 /FiO 2 ] mmHg, p < 0.001), PaO 2 (88.15 [76.62-112.0] mmHg vs. 65.65 [57.07-81.22] mmHg, p < 0.001), and SpO 2 (96 [95-98]% vs. 94 [90-96]%, p < 0.001) was observed. A concomitant decrease in C-reactive protein and ferritin levels was found (132.

Remdesivir significantly reduces SARS‐CoV‐2 viral load on nasopharyngeal swabs in hospitalized patients with COVID‐19: A retrospective case–control study

“… 1 Moreover, the identification of early predictors for severe disease (i.e., low admission eGFR) 22 could help in the risk stratification to choose the best treatment strategies (i.e., high‐dose glucocorticoids treatment or other immunomodulating drugs). 21 , 23 …”

“…First, the optimal timing for remdesivir administration to prevent disease progression and complication is still under evaluation 1 . Moreover, the identification of early predictors for severe disease (i.e., low admission eGFR) 22 could help in the risk stratification to choose the best treatment strategies (i.e., high‐dose glucocorticoids treatment or other immunomodulating drugs) 21,23 …”

PBPK Modelling of Dexamethasone in Patients With COVID-19 and Liver Disease

“…Additionally, first-pass metabolism is thought to be impacted by the shunt effect, increasing a drug's bioavailability, yet the impact of shunting on the AUC0-24 and CL of DEX remained minimal. Simulations of DEX 20 mg IV and PO once a day were made since higher doses are being investigated to present clinical improvement and decrease in inflammatory biomarkers in patients hospitalized with COVID-19, but remain unproven (Vecchié et al, 2021). However, the AUC ratio between healthy and individuals with LD remained comparable to the lower dose (6 mg once a day), showing linear PK.…”

Drugs for COVID-19: An Update

“…Dexamethasone, a synthetic corticosteroid, is a glucocorticoid used to treat asthma, allergic reactions, arthritis and other autoimmune diseases [ 83 ]. A retrospective observational study showed that a high dose of dexamethasone induced a significant improvement in clinical and laboratory parameters in hospitalized COVID-19 patients under the hyperinflammatory phase [ 84 ]. In another study, the effectiveness of low doses of dexamethasone was compared to the usually used high dosage [ 82 ].…”