Dexamethasone Underused for Adults Hospitalized With COVID-19

For adults hospitalized with COVID-19, dexamethasone and remdesivir use increased over time, although dexamethasone is still somewhat underused, according to a study published online Aug. 17 in the Annals of Internal Medicine.

Hemalkumar B. Mehta, Ph.D., from the Johns Hopkins Bloomberg School of Public Health in Baltimore, and colleagues characterized the use of hydroxychloroquine, remdesivir, and dexamethasone in a retrospective cohort study conducted at 43 U.S. health systems involving 137,870 adults hospitalized with COVID-19 between Feb. 1, 2020, and Feb. 28, 2021.

The researchers found that during the study period, 6.3, 21.2, and 39.1 percent of patients received hydroxychloroquine, remdesivir, and dexamethasone, respectively. About 78 to 84 percent of people who have had invasive ventilation have received dexamethasone or other glucocorticoids in the time period following the release of the results from the Randomised Evaluation of COVID-19 Therapy trial in mid-June 2020. Hydroxychloroquine use increased during March 2020, peaking at 42 percent, then started decreasing by April 2020. In contrast, during the study period, remdesivir and dexamethasone use increased gradually. There was considerable variation in dexamethasone and remdesivir use across health centers (intraclass correlation coefficient, 14.2 and 84.6 percent, respectively).

"Mehta and colleagues clearly showed how rapidly clinicians can navigate a cacophony of data and incorporate important and meaningful results of clinical research into practice during an infectious disease pandemic," write the authors of an accompanying editorial.