麻豆传媒

For COVID-19 patients who had less than a 10-day dexamethasone course during their hospital stay, giving extra doses following discharge was not associated with improved mortality or readmission rates, a retrospective study found.

Among over 1,100 such patients treated early in the pandemic, inverse probability treatment weighting showed similar rates for the composite outcome -- all-cause readmissions or mortality within 14 days of discharge -- for those who received a 6-mg daily course of dexamethasone post-discharge and those who did not, at 9.1% versus 11.4%, respectively (adjusted odds ratio [aOR] 0.87, 95% CI 0.58-1.30), reported Cheng-Wei Huang, MD, of the Kaiser Permanente Los Angeles Medical Center, and colleagues.

For mortality specifically, 0.9% of those receiving the extra doses died within 14 days as compared to 0.8% of those who did not, according to their findings in .

A sensitivity analysis looking at patients treated for exactly 10 days during their hospital stay showed a similar result for the composite outcome, and exploratory analyses of different subgroups showed no significant benefit for the extra corticosteroid doses:

• 1 to 3 days of inpatient dexamethasone: aOR 0.71 (95% CI 0.43-1.16)
• 4 to 9 days of inpatient dexamethasone: aOR 1.01 (95% CI 0.48-2.12)
• Needing only room air at discharge: aOR 0.91 (95% CI 0.53-1.59)
• Needing supplemental oxygen at discharge: aOR 0.76 (95% CI 0.42-1.37)
• ≤10 days disease duration at discharge: aOR 0.81 (95% CI 0.49-1.33)
• >10 days disease duration at discharge: aOR 0.94 (95% CI 0.48-1.86)

"Our findings suggest that dexamethasone, short of other indications, should not be routinely prescribed beyond discharge for treatment in patients with COVID-19," Huang's group concluded. "Although our study was done early in the pandemic, our findings remain of relevance in today's practice, especially because corticosteroids have become a cornerstone therapy for COVID-19."

The U.K. RECOVERY trial showed that giving dexamethasone for up to 10 days in hospitalized COVID-19 patients reduces mortality. However, any potential benefit beyond discharge is unclear, Huang's group noted.

For their study, the researchers examined electronic health records data on 1,164 patients who were hospitalized for lab-confirmed COVID-19 and received dexamethasone during their stay at one of 15 Kaiser Permanente Southern California medical centers from May 1 to Sept. 30, 2020. Median duration of dexamethasone treatment was 4 days during hospitalization. ICD-10 codes identified index hospitalizations, and patients discharged to other facilities, hospice, or against medical advice were excluded.

Among these, 692 received dexamethasone after discharge (defined as a filled prescription of 6 mg per day) and 472 did not. The majority of patients were Hispanic (71%), the median age was 55 years, and 58% were men. Average BMI was 31, and nearly two-thirds had three or fewer Elixhauser comorbidities.

Nearly all (90%) required oxygen support while hospitalized and about half required supplemental oxygen at discharge. For other COVID therapies, 54% received remdesivir (Veklury), 31% were given convalescent plasma, 16% received therapeutic anticoagulation, and 5% received biologics.

Inverse probability treatment weighting adjusted for demographics, BMI, comorbidities, and other prescribed therapies.

The authors acknowledged several limitations to the data, including potential bias and confounders such as a lack of data on corticosteroid use prior to hospitalization. Also, the only direct measure of disease severity assessed was the required use of oxygen.

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