Results from a Duke Clinical Research Institute study that were recently published in JAMA Network Open expand the depth of understanding of how dexamethasone can improve outcomes among patients hospitalized with COVID-19, particularly when administered early.
Early administration of the corticosteroid dexamethasone for hospitalized COVID-19 patients on supplemental oxygen or mechanical ventilation reduced the odds of patient death or discharge to hospice.
DCRI Fellow Ahmad Mourad, MD, and DCRI faculty Dylan Thibault, MS, Thomas Holland, MD and Laine Thomas, PhD, authored “Dexamethasone for Inpatients With COVID-19 in a National Cohort” with additional researchers from Meta Platforms, Inc., Biobot Analytics, and HCA Healthcare Research Institute. Results of the study build on what was learned from the RECOVERY trial, and provides new insights on how the corticosteroid affects different subgroups of patients.
“In the months to years following the publication of the seminal RECOVERY trial that randomized hospitalized patients with COVID-19 to receive Dexamethasone, corticosteroids remain the backbone of treatment for severe COVID-19. However, the population of patients afflicted with COVID-19 has changed dramatically since the days of the RECOVERY trial,” said Mourad, a first-year DCRI Fellow and the paper’s first author. “Vaccination, population level immunity, new SARS-CoV-2 variants, and widely available antiviral medications have fundamentally altered the course of the disease. Given these developments, we sought to use real-world data to evaluate whether Dexamethasone is still beneficial for hospitalized patients with COVID-19, and to explore important patient subgroups that were not included in the clinical trials.”
Using data from more than 80,000 hospitalized COVID-19 patients throughout the United States between July 2020 and October 2021, researchers grouped patients into one of four cohorts based on the degree of supplemental oxygen support they required during their hospitalization:
- no supplemental oxygen
- supplemental oxygen
- noninvasive positive pressure ventilation
- mechanical ventilation or extracorporeal mebrane oxygenation (ECMO)
“Using target trial emulation, our team was able to analyze data from the largest national retrospective cohort to answer these questions,” Mourad said. “This project was a collaboration across departments and areas of expertise that spanned over two years. Through Dr. Laine Thomas’ dedication to the science and novel methodology in conducting these analyses, our team overcame many challenges to bring this research to fruition. I’ve learned much from this team, including our lead biostatistician Dylan Thibault; most importantly, that utilizing novel methods in causal inference is crucial for advancing knowledge using observational data.”