Systematic Reviews
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Sep 25, 2024; 13(3): 95709
Published online Sep 25, 2024. doi: 10.5501/wjv.v13.i3.95709
Dosage and utilization of dexamethasone in the management of COVID-19: A critical review
Imran Sethi, Asim Shaikh, Musa Sethi, Hira Khalid Chohan, Sheraz Younus, Syed A Khan, Salim Surani
Imran Sethi, Department of Critical Care Medicine, Marion General Hospital, Marion, IN 46952, United States
Asim Shaikh, Department of Medicine, Aga Khan University, Karachi 74200, Sindh, Pakistan
Musa Sethi, Department of Medicine, Eman School, Fishers, IN 46038, United States
Hira Khalid Chohan, Department of Internal Medicine, Dow University of Health Science, Karachi 74200, Sindh, Pakistan
Sheraz Younus, Department of Hospital Medicine, Franciscan Health, Indianapolis, IN 46237, United States
Syed A Khan, Department of Critical Care Medicine, Mayo Clinic Health System, Mankato, MN 56001, United States
Salim Surani, Department of Medicine and Pharmacology, Texas A and M University, College Station, TX 77843, United States
Author contributions: Sethi I provided the conceptualization; Sethi I, Shaikh A, Sethi M, Chohan HK, and Younus S provided the literature review, drafting, and reviewing; Sethi I, Shaikh A, Sethi M agreed to the final accuracy of the work; Khan SA and Surani S provided supervision, idea generation, and critical final review of the manuscript.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
PRISMA 2009 Checklist statement: The authors have read the PRISMA 2009 Checklist, and the manuscript was prepared and revised according to the PRISMA 2009 Checklist.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Salim Surani, FACP, FCCP, MD, MHSc, Adjunct Professor, Department of Medicine and Pharmacology, Texas A and M University, 40 Bizzell Street, College Station, TX 77843, United States. srsurani@hotmail.com
Received: April 16, 2024
Revised: May 27, 2024
Accepted: June 19, 2024
Published online: September 25, 2024
Processing time: 134 Days and 19 Hours
Abstract
BACKGROUND

The severe respiratory manifestations observed in severe coronavirus disease 2019 (COVID-19) cases are often associated with an excessive inflammatory response. Dexamethasone, a synthetic glucocorticoid, exerts its anti-inflammatory effects by inhibiting the transcription of pro-inflammatory genes and suppressing the activity of various immune cells. This mechanism has implications for mitigating the cytokine storm observed in severe COVID-19 cases. Early on in the pandemic, the Recovery Collaborative working group showed a mortality benefit of using dexamethasone in decreasing mortality in patients with COVID-19 requiring respiratory support. However, the optimal dosage of corticosteroids remains debatable. Several studies that compare different doses of dexamethasone in COVID-19 exist, but the results are conflicting.

AIM

To review the latest evidence regarding dosage, safety, and efficacy of dexamethasone in severe COVID-19.

METHODS

We followed preferred reporting items for systematic reviews and meta-analysis guidelines. A detailed literature search was conducted across PubMed, Google Scholar, and Medline to include publications up to March 2024. Our keywords included “COVID-19” “SARS-CoV-2” “dexamethasone” “corticosteroid” “steroid” and “glucocorticoid”-along with their combinations. We employed the Cochrane Risk of Bias Tool and the Newcastle-Ottawa scale to evaluate the integrity and potential of bias in the included studies. A meta-analysis was conducted using a random-effects model, assessing pooled odds ratios and mean differences, with heterogeneity gauged by the I2 statistic and the χ2 tests.

RESULTS

No statistical differences were found in 28-day all-cause mortality [pooled odds ratio (OR) = 1.109, 95%CI: 0.918-1.340], 60-day all-cause mortality (OR = 0.873, 95%CI: 0.744-1.024; I2 = 47.29%), mean length of hospital stay (mean difference = -0.08 days, 95%CI: -0.001 to 0.161) and adverse events (OR = 0.877, 95%CI: 0.707-1.087).

CONCLUSION

Differing doses of corticosteroids have no clinical implications on mortality, mean length of hospital stay, and adverse events in COVID-19 patients. Additional research is required in patients requiring invasive or non-invasive ventilation.

Keywords: COVID-19; Steroids; Corticosteroids; Steroid dosage; Critical care; Corona virus

Core Tip: The role of steroid dosing in coronavirus disease 2019 (COVID-19) patients remains a critical area of focus especially concerning the reduction of COVID-19-associated mortality and improvement of overall serious outcomes. Numerous trials have recently been published evaluating outcomes with different steroid dosage regimens. Our meta-analysis shows that higher steroid dosing does not significantly improve serious outcomes and does not result in the reduction of serious adverse events. Therefore, barring additional studies evaluating the role of higher dosages according to stratification of various demographic factors, we do not recommend escalating doses of steroids to curb mortality or hospital stay duration in critical patients.