Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Dexamethasone Low Dose vs Dexamethasone High Dose

This comparison will not be updated. Last search date 14 Dec, 2022.

Studies included but not extracted/included in the analysis: Wu H, PloS one, 2022

Hospitalized patients

Forest plots
(last update: 2022-08-04)

Summary of findings
(last update: 2022-09-27)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Dexamethasone Low Dose
Comparison: Dexamethasone High Dose

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.02 (0.92 - 1.13)	17 more per 1000 (from 69 fewer to 113 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, outcome measurement and selection of the reported results Inconsistency: Not serious Indirectness: Serious single study from a single institution therefore results in this population might not be generalizable to other settings Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Taboada M, 2021 200 participants		Dexamethasone Low Dose 885 per 1,000 (798 - 980)	Dexamethasone High Dose 867 per 1,000
Clinical improvement D60	Outcome not yet measured or reported
WHO progression score (level 7 or above) D28	RR: 1.12 (0.39 - 3.22)	7 more per 1000 (from 37 fewer to 136 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, and selection of the reported results Inconsistency: Not serious Indirectness: Serious single study from a single institution therefore results in this population might not be generalizable to other settings Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Taboada M, 2021 200 participants		Dexamethasone Low Dose 69 per 1,000 (24 - 197)	Dexamethasone High Dose 61 per 1,000
WHO progression score (level 7 or above) D60	Outcome not yet measured or reported
All-cause mortality D28	RR: 0.92 (0.59 - 1.44)	14 fewer per 1000 (from 73 fewer to 78 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Taboada M, 2021; Maskin LP, 2021 300 participants		Dexamethasone Low Dose 163 per 1,000 (104 - 255)	Dexamethasone High Dose 177 per 1,000
All-cause mortality D60	RR: 0.88 (0.63 - 1.24)	31 fewer per 1000 (from 94 fewer to 61 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns regarding deviation from intended intervention, missing data, and selection of the reported results Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
4 trials Taboada M, 2021; Toroghi N, 2021; Maskin LP, 2021; Bouadma L, 2022 946 participants		Dexamethasone Low Dose 224 per 1,000 (160 - 315)	Dexamethasone High Dose 254 per 1,000
Viral negative conversion D7	Outcome not yet measured or reported
Adverse events	RR: 1.01 (0.92 - 1.12)	7 more per 1000 (from 59 fewer to 89 more)		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
1 trials Bouadma L, 2022 550 participants		Dexamethasone Low Dose 747 per 1,000 (681 - 829)	Dexamethasone High Dose 740 per 1,000
Serious adverse events	Outcome not yet measured or reported

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=520

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04344730 ; EudraCT 2020-001457-43 COVIDICUS Bouadma L, JAMA Intern Med, 2022 Full text Commentary Commentary	Mixed	Dexamethasone Low Dose	Dexamethasone High Dose	RCT	Patients with confirmed COVID-19 (severe-critical) admitted to 19 centers in France.	N=550	Some concerns Details	Full description
NCT04726098 ; EudraCT 2020-005702-25 Taboada M, Eur Respir J, 2021 Full text Commentary	Public/non profit	Dexamethasone Low Dose	Dexamethasone High Dose	RCT	Patients with confirmed COVID-19 (moderate) admitted to a single center in Spain.	N=200	Some concerns Details	Full description
IRCT20100228003449N31 Toroghi N, Pharmacol Rep, 2021 Full text Commentary	Public/non profit	Dexamethasone High Dose Dexamethasone Low Dose	Dexamethasone Low Dose Dexamethasone intermediate dose	RCT	Patients with suspected or confirmed COVID-19 (moderate/severe) admitted to a single center in Iran.	N=144	Some concerns Details	Full description
N/A Montalvan E, Chest, 2021 Full text Commentary	Not reported/unclear	Dexamethasone High Dose	Dexamethasone Low Dose	RCT	Patients with suspected or confirmed COVID-19 (unclear severity) admitted to a single center in Honduras.	N=81	N/A	Full description
NCT04395105 Maskin LP, Intensive Care Med, 2021 Full text Full text Commentary Commentary Commentary	No specific funding	Dexamethasone High Dose	Dexamethasone Low Dose	RCT	Patients with confirmed COVID-19 (critical) admitted to 4 centers in Argentina.	N=100	Some concerns Details	Full description