| 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" Comment: The allocation sequence was concealed. |
| Deviations from intervention |
Some concerns |
Comment: Unblinded study.
In the intervention arm, 1975/2079 received dexamethasone. In the control arm, 336/4278 received dexamethasone. Deviation too small to affect the outcome. No information on administration of co-interventions of interest: glucocorticoids and anticoagulants. Antivirals and biologics were reported. Data were analyzed using intention-to-treat analysis. |
| Missing outcome data |
Low |
Comment: 6425 randomized, 6425 analyzed. Risk assessed to be low for the outcomes: Mortality, Clinical improvement and Score 7 or above on the WHO scale |
| Measurement of the outcome |
Some concerns |
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 and Score 7 or above on the WHO Scale. Risk assessed to be some concerns for the outcome: Clinical improvement since this outcome involves clinical decision-making. |
| Selection of the reported results |
Low |
Comment: The protocol and statistical analysis plan were available. Risk assessed to be low for the outcomes: Mortality, Clinical improvement and Score 7 and above on the WHO scale . |
| Overall risk of bias |
Some concerns |