Dexamethasone Dose for COVID-19 in a Large U.S. Hospital Network From April 2020 to May 2023.

IF 2.4 4区医学 Q3 PHARMACOLOGY & PHARMACY Pharmacoepidemiology and Drug Safety Pub Date : 2024-10-01 DOI:10.1002/pds.70018

Marie C Bradley, Ashish Rai, Austin Cosgrove, Silvia Perez-Vilar, Candace Fuller, Edward Rosen, Efe Eworuke, Laura E McLean, Jeffrey S Guy, Russell E Poland, Kenneth E Sands, Gerald J Dal Pan

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Abstract

Purpose: While potential harm from high doses of systemic dexamethasone for clinical management of COVID-19 is an important concern, little is known about real world dexamethasone dosing in patients hospitalized with COVID-19 in the United States.

Methods: Descriptive study to assess dexamethasone daily dose in adults with COVID-19 in a large US hospital network, overall and by respiratory support requirements, extracted using semi- structured nursing notes.

Results: Of 332 430 hospitalizations with a COVID-19 diagnosis, 201 637 (60.7%) hospitalizations included dexamethasone administration. The mean age of recipients was 63 years, 53.0% were male, and 64.5% White. Median time from admission to dexamethasone administration was 0 day (interquartile range [IQR], 0-1 days) and median duration of use was 5 (IQR, 3-9) days. Almost 80% of hospitalizations received standard daily doses (≤ 6 mg daily), 12.7% moderately high daily doses (> 6- ≤ 10 mg daily), and 8.1% high (> 10- ≤ 20 mg daily) or very high daily dose (> 20 mg daily). Over 20% of COVID-19 hospitalizations requiring no oxygen or simple oxygen received high doses of systemic dexamethasone.

Conclusions: Given the findings from the UK RECOVERY trial, and the general uncertainty around safety of higher dexamethasone doses in those requiring more intense respiratory support, standard daily dexamethasone doses of 6 mg or less for hospitalized COVID-19 requiring supplemental oxygen are recommended.

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2020 年 4 月至 2023 年 5 月美国大型医院网络中 COVID-19 的地塞米松剂量。

目的：在COVID-19的临床治疗中，大剂量全身使用地塞米松可能会造成危害，这是一个值得关注的重要问题，但在美国，人们对COVID-19住院患者的实际地塞米松剂量知之甚少：描述性研究：通过半结构化护理记录，评估美国大型医院网络中 COVID-19 成人患者的地塞米松日剂量，包括总体剂量和呼吸支持需求剂量：在确诊为 COVID-19 的 332 430 例住院病例中，有 201 637 例（60.7%）住院病例使用了地塞米松。接受治疗者的平均年龄为 63 岁，53.0% 为男性，64.5% 为白人。从入院到使用地塞米松的中位时间为 0 天（四分位数间距 [IQR]，0-1 天），中位使用时间为 5 天（IQR，3-9 天）。近80%的住院患者接受了标准日剂量（每日≤6毫克），12.7%的患者接受了中高日剂量（> 6- ≤ 10毫克/日），8.1%的患者接受了高日剂量（> 10- ≤ 20毫克/日）或超高日剂量（> 20毫克/日）。在COVID-19住院患者中，超过20%的患者需要不吸氧或简单吸氧，并接受了大剂量的全身地塞米松治疗：结论：鉴于英国 RECOVERY 试验的结果，以及对需要更多呼吸支持的患者使用高剂量地塞米松的安全性普遍存在不确定性，建议对需要补充氧气的 COVID-19 住院患者使用每日 6 毫克或更少的地塞米松标准剂量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Pharmacoepidemiology and Drug Safety 医学-药学

CiteScore

4.80

自引率

7.70%

发文量

173

审稿时长

3 months

期刊介绍： The aim of Pharmacoepidemiology and Drug Safety is to provide an international forum for the communication and evaluation of data, methods and opinion in the discipline of pharmacoepidemiology. The Journal publishes peer-reviewed reports of original research, invited reviews and a variety of guest editorials and commentaries embracing scientific, medical, statistical, legal and economic aspects of pharmacoepidemiology and post-marketing surveillance of drug safety. Appropriate material in these categories may also be considered for publication as a Brief Report. Particular areas of interest include: design, analysis, results, and interpretation of studies looking at the benefit or safety of specific pharmaceuticals, biologics, or medical devices, including studies in pharmacovigilance, postmarketing surveillance, pharmacoeconomics, patient safety, molecular pharmacoepidemiology, or any other study within the broad field of pharmacoepidemiology; comparative effectiveness research relating to pharmaceuticals, biologics, and medical devices. Comparative effectiveness research is the generation and synthesis of evidence that compares the benefits and harms of alternative methods to prevent, diagnose, treat, and monitor a clinical condition, as these methods are truly used in the real world; methodologic contributions of relevance to pharmacoepidemiology, whether original contributions, reviews of existing methods, or tutorials for how to apply the methods of pharmacoepidemiology; assessments of harm versus benefit in drug therapy; patterns of drug utilization; relationships between pharmacoepidemiology and the formulation and interpretation of regulatory guidelines; evaluations of risk management plans and programmes relating to pharmaceuticals, biologics and medical devices.