By Kelly Young
NEJM Journal Watch
Edited by Susan Sadoughi, MD, and Richard Saitz, MD, MPH, FACP, DFASAM
The World Health Organization recommends systemic corticosteroids to treat patients with severe and critical COVID-19. The guidance coincides with the publication of three randomized trials and a meta-analysis on corticosteroids in JAMA.
The WHO recommends 6 mg of dexamethasone orally or intravenously daily or 50 mg of hydrocortisone intravenously every 8 hours for 7 to 10 days in the most seriously ill patients.
The organization also suggests that corticosteroids not be used to treat patients with milder COVID-19, as they may increase mortality risk in these patients.
In the WHO-sponsored meta-analysis, researchers examined the results of seven trials of corticosteroids versus usual care or placebo among some 1700 critically ill COVID-19 patients. The 28-day mortality rate, the primary outcome, was significantly lower among corticosteroid users (32% absolute mortality for corticosteroids vs. 40% assumed mortality for controls).