| Bias | Author's judgement | Support for judgement |
| Randomization |
Low |
Quote: "Eligible and consenting patients were assigned in a ratio of 2:1 to either usual standard of care or to usual standard of care plus dexamethasone 6 mg once daily (oral or intravenous) for up to 10 days (or until discharge if sooner) or to one of the other suitable and available treatment arms (see Supplementary Appendix) using web- based simple randomization" |
| Deviations from intervention |
Some concerns |
Comment: Unblinded study. Co-intervention administration for antimaria, antivirals (lopinavir/ritonavir) and biologics is balanced. 285 participants in the control arm (7%) recieved the experimental treatment. Data were analyzed by using intent-to-treat analysis. |
| Missing outcome data |
Low |
Low Comment: 6425 randomized, 6425 analyzed. Risk assessed to be "low" for the outcomes: Mortality. |
| Measurement of the outcome |
Low |
Comment: The trial was not blinded participants or local study staff. Outcomes are observer-measured and do not involve clinical decision-making or involve assessor judgment. Risk assessed to be "low" for the outcomes: Mortality. |
| Selection of the reported results |
Low |
Comment: the protocol and statistical analysis plan were available. Risk assessed to be low for the outcomes: Mortality. |
| Overall risk of bias |
Some concerns |