Dexametasone treatment in case of COVID-19 infection: Rapid Health Technology Assessment Report

Abstract

INTRODUCTION: the recent publication of the preliminary results of a multicenter randomized trial reporting the effectiveness of dexamethasone treatment in patients with severe SARS-CoV-2 infection; raises the need to conduct a literature review,  identify and critically assess the evidence on the effectiveness and safety of this intervention. METHODS: a broad, non- systematic search was carried out. The GRADE methodology was used to assess the certainty of the included evidence. A  multidisciplinary team was formed to carry out a Health Technology Assessment report. RESULTS: the use of glucocorticoids  (dexamethasone 6 mg / day for 10 days) in patients with COVID-19 pneumonia will reduce global mortality at 28 days, (RR 0.83,  95% CI 0.75 to 0.93), with a number necessary to treat (NNT) of 33, (High confidence). In patients with severe pneumonia  requiring mechanical ventilation (MV), a decrease in mortality was reported (RR, 0.64; 95% CI, 0.51 to 0.81, NNT 8.5) (Moderate  confidence). In patients with severe pneumonia with oxygen requirements without MV, it reports a reduction in mortality (RR,  0.82;  95% CI, 0.72 to 0.94), (Moderate confidence). The adverse effects of corticosteroids in critically ill patients have not been  described with these doses used. DISCUSSION: the administration of dexamethasone 6 mg / day (low doses) for 10 days is recommended in patients with SARS-CoV-2 associated severe pneumonia and oxygen or mechanical ventilation requirements.