Large clinical data on the treatment of new crown pneumonia by dexamethasone for the treatment of severe patient mortality were released.

Recently, the team of researchers in the Recovery randomized control of large clinical trials in the New England Journal of Medicine published the results of a low-dose dessemin in the treatment of patients with ADMITTED COVID-19 in the RECOVERY clinical trial.
this large randomized controlled, open-label clinical trial showed that the use of dexamethasone in patients receiving mechanical ventilation or oxygen absorption reduced mortality within 28 days of treatment.
However, for patients who do not need respiratory support, dexamethasone does not provide mortality benefits.
trial design recovery clinical trial is a randomized controlled clinical trial conducted by Oxford University and the UK government in a series of potential treatments for COVID-19, including low-dose semiamson.
more than 11,500 patients were enrolled in hospitals in more than 175 NHS systems in the UK.
a total of 2,104 patients were treated at random with dexamethasone (6 mg, once a day, 10 days of treatment) in the patient group treated with dexamethasone and compared with 4,321 patients who received routine treatment at random.
the main therapeutic outcomes overall, the 28-day mortality rate in the patient group treated with dexamethasone was 22.9% (482/2104), significantly lower than that of the patient group receiving routine treatment (25.7%, p-lt;0.001). Analysis of different subgroups by the
showed that patients receiving mechanical ventilation benefited the most, with a mortality rate of 29.3% for patients receiving dexamethasone and 41.4% in the control group.
the mortality rate of dexamethasone was 23.3% in patients receiving oxygen but did not need mechanical ventilation, compared with 26.2% in the control group.
However, for patients who did not need any respiratory support, dexamethasone did not provide significant benefits, with a mortality rate of 17.8%, slightly higher than the control group's 14.0.
the main efficacy data of dexamethasone (Photo source: References) Some discussion researchers noted in the discussion of the paper that glucocorticoids have been widely used in respiratory diseases closely related to COVID-19, including SARS, MERS syndrome, and severe influenza and community-acquired pneumonia.
however, the lack of evidence from large controlled clinical trials supports or opposes the use of glucocorticoids.
the benefits of glucocorticoids may be related to the dose used, the time, and the patient's characteristics.
high doses of glucocorticoids may do more harm than good when virus replication needs to be controlled and inflammation is minimal.
unlike SARS, COVID-19 patients reached a peak in the fall off of the new coronavirus early in the disease and then gradually declined.
in this trial, patients who needed respiratory support, as well as those who entered the group one week after the onset of the disease, benefited more from mortality, suggesting that the dominant factor in disease progression at this stage was immunopathologicalfactors, with active viral replication playing only a secondary role.
because of differences in the history of COVID-19 and other respiratory diseases in the history of natural morbidity, the researchers warned that it would not be appropriate to extend the effects of dexamethasone in the treatment of COVID-19 patients to other diseases.
References: the Collaborative RECOVERY Group. (2020). Dexamethasone in Seied Patientswith Covid-19 - Preliminary Report. The New England Journal of Medicine, DOI: 10.1056/NEJMoa2021436 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .