Intermediate- to high-dose dexamethasone versus low-dose dexamethasone in patients with COVID-19 requiring respiratory support: a systematic review and meta-analysis of randomized trials

被引:5
|
作者
Kow, Chia Siang [1 ]
Ramachandram, Dinesh Sangarran [2 ]
Hasan, Syed Shahzad [3 ,4 ]
机构
[1] Int Med Univ, Sch Pharm, 126 Jalan Jalil Perkasa, Kuala Lumpur, Malaysia
[2] Monash Univ Malaysia, Sch Pharm, Bandar Sunway, Selangor, Malaysia
[3] Univ Huddersfield, Sch Appl Sci, Huddersfield, England
[4] Univ Newcastle, Sch Biomed Sci & Pharm, Callaghan, Australia
关键词
COVID-19; Corticosteroid; Death; Glucocorticoid; Steroid;
D O I
10.1007/s10787-023-01251-8
中图分类号
R392 [医学免疫学]; Q939.91 [免疫学];
学科分类号
100102 ;
摘要
The present review critically appraised the randomized clinical trials that compared mortality outcomes between intermediate- to high-dose dexamethasone and low-dose dexamethasonein patients with COVID-19 and reported pooled mortality risk estimates associated with these two dosing regimens of dexamethasone. The systematic searching of electronic databases was limited to randomized clinical trials that compared mortality outcomes between intermediate- to high-dose dexamethasone with low-dose dexamethasone in patients with COVID-19 requiring respiratory support. The primary outcome of interest in this review was all-cause mortality. A total of eight trials with 1800 patients randomized to receive intermediate to high-dose dexamethasone and 1715 patients randomized to low-dose dexamethasone were included. The meta-analysis of six trials revealed no significant difference in the risk of 28-day all-cause mortality between intermediate- to high-dose dexamethasone and low-dose dexamethasone (odds ratio 1.16, 95% confidence interval, 0.77-1.74). Similarly, the meta-analysis of five trials revealed no significant difference between the two doses regarding 60-day all-cause mortality (odds ratio 0.96, 95% confidence interval 0.74-1.26). The results suggest intermediate- to high-dose dexamethasone to be as effective as low-dose dexamethasone in reducing the risk of mortality among patients with COVID-19 requiring respiratory support. However, higher dexamethasone doses could expose patients with COVID-19 to an increased risk of adverse events, such as hyperglycemia.
引用
收藏
页码:2773 / 2779
页数:7
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