Respiratory failure & ventilation
Which severe COVID-19 patients could benefit from high dose dexamethasone? A Bayesian post-hoc reanalysis of the COVIDICUS randomized clinical trial
An erratum to this article was published (Ann Intensive Care, 29 Sep 2023 ↗)
Authors' conclusion
In this exploratory post hoc Bayesian analysis, compared with standard-of-care DXM, high-dose DXM may benefit patients aged less than 70 years with severe ARF that occurred less than 7 days after symptoms onset. The use of remdesivir may also favour the benefit of DXM20.
Study context
- Population
- Severe SARS-Cov2 patients with acute respiratory failure who received DXMSoc or dexamethasone (DXM20) in the COVIDICUS trial
- Participants
- 473 patients
- Comparison
- High-dose dexamethasone vs standard-of-care 6 mg dexamethasone
Methodological detailspost hoc, exploratory, Bayesian, noninformative priors, sensitivity analyses with sceptical and enthusiastic priors
- Post hoc
- Exploratory
- Bayesian
- Noninformative priors
- Sensitivity analyses with sceptical and enthusiastic priors
Primary result
As reported in the abstract
Subgroup interactions, 60 day mortality (DXM20 vs DXMSoC) · 60 day
- Age: Pr Interact
- 84%
- Age below 70: probability of benefit
- 86.5%
- Age above 70: probability of benefit
- 22%
- Time since symptoms onset: Pr Interact
- 99%
- Onset lower than 7 days: probability of more than trivial benefit
- 99.9%
- Onset delayed by 7 days or more: probability of more than trivial benefit
- < 0.1%
- Remdesivir use: Pr Interact
- 91%
- Receiving remdesivir: probability of benefit
- 90.1%
- Not receiving remdesivir: probability of benefit
- 19.1%
Further findings
Overall 60 day mortality
- Posterior probability of more than trivial benefit (HR < 0.95)
- 29.0%
- Posterior probability of potential harm (HR > 1.05)
- 51.1%
Parts of this Brief are withheld: the automatic checks could not confirm them against the abstract.
Original publication
Which severe COVID-19 patients could benefit from high dose dexamethasone? A Bayesian post-hoc reanalysis of the COVIDICUS randomized clinical trial. Ann Intensive Care. Published 27 August 2023. doi:10.
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