Continuing the corticosteroid dexamethasone after hospital release didn't benefit COVID-19 patients who did not complete the 10-day drug regimen during their stay, according to a recent study.
Kaiser Permanente Southern California researchers studied the continuing use of dexamethasone at a dosage of 6mg per day after hospital release in 1,164 adult COVID-19 patients released from 1 of 15 hospitals from 1 May to 30 September 2020.
Among the 1,164 patients, 59.5% continued dexamethasone after hospital release. Median patient age was 55 years, 70.6% were Hispanic, 57.9% were men, and 90.0% needed supplemental oxygen during hospitalisation.
The rate of hospital readmission or death within 14 days of release was 9.1% in patients who continued dexamethasone, compared with 11.4% among patients who didn’t, but the difference wasn’t statistically significant, reports the study, which was published in JAMA Network Open.
The adjusted odds ratio (OR) for readmission or death within 14 days was 0.87 (95% confidence interval [CI], 0.58 to 1.30) for patients who continued dexamethasone, compared with those who did not. A sensitivity analysis that limited the treatment group to those given exactly 10 days of dexamethasone showed comparable results (OR, 0.89; 95% CI, 0.55 to 1.43).
A subgroup analysis stratified by length of dexamethasone therapy in the hospital also yielded similar findings (1 to 3 days: OR, 0.71; 4 to 9 days: OR, 1.01), oxygen requirement at release (room air: OR, 0.91; supplemental oxygen use: OR, 0.76), and illness duration at release (10 days or less: OR, 0.81; more than 10 days: OR, 0.94).
The study authors noted that corticosteroids like dexamethasone were the first type of medication to show a survival benefit in severely ill COVID-19 patients and are now a mainstay of hospital treatment. Because early readmissions after hospital release are largely due to respiratory causes that probably reflect illness progression, the authors had theorised that continuing corticosteroids could reduce these outcomes.
“Continuing treatment with dexamethasone, 6mg/d, at discharge was not associated with a reduction in 14-day all-cause readmission or mortality,” the researchers wrote. “This finding suggests that dexamethasone should not be routinely prescribed beyond discharge.”
Study details
Association Between Dexamethasone Treatment After Hospital Discharge for Patients With COVID-19 Infection and Rates of Hospital Readmission and Mortality
Cheng-Wei Huang, Albert Yu, Hubert Song, Joon S. Park, M, Stefanie Wu, Vang Kou Khang, Christopher Subject, Ernest Shen.
Published in JAMA Open Network on 8 March 2022
Key Points
Question Is continuing use of dexamethasone, 6 mg/d, at discharge for patients with COVID-19 who received less than 10 days of dexamethasone treatment during hospitalisation associated with readmission or mortality after discharge?
Findings In a cohort of 1164 patients with COVID-19 who received less than 10 days of dexamethasone, 6 mg/d, during hospitalisation, the rate of readmission or mortality within 14 days of discharge was 9.1% among patients who continued dexamethasone treatment compared with 11.4% among patients who did not. The difference was not statistically significant.
Meaning The findings of this study suggest that prescribing dexamethasone at discharge for patients hospitalised with COVID-19 who received less than 10 days of dexamethasone is not associated with a reduction in readmission or mortality.
Abstract
Importance Current guidelines recommend use of dexamethasone, 6 mg/d, up to 10 days or until discharge for patients hospitalised with COVID-19. Whether patients who received less than 10 days of corticosteroids during hospitalisation for COVID-19 benefit from continuing treatment at discharge has not been determined.
Objective To assess whether continuing dexamethasone treatment at discharge is associated with reduced all-cause readmissions or mortality postdischarge.
Design, Setting, and Participants A retrospective cohort study was conducted at 15 medical centers within Kaiser Permanente Southern California. The population included adults who received less than 10 days of dexamethasone, 6 mg/d, until discharge during hospitalisation for COVID-19 and were discharged alive between May 1 and September 30, 2020.
Exposures Continued dexamethasone treatment at discharge.
Main Outcomes and Measures All-cause readmissions or mortality within 14 days from discharge.
Results
A total of 1164 patients with a median age of 55 (IQR, 44-66) years were identified. Most patients were of Hispanic ethnicity (822 [70.6%]) and male (674 [57.9%]) and required oxygen support during hospitalization (1048 [90.0%]). Of the 1164 patients, 692 (59.5%) continued dexamethasone, 6 mg/d, at discharge. A balanced cohort was created using propensity score and inverse probability of treatment weighting. The adjusted odds ratio (OR) for readmissions or mortality within 14 days was 0.87 (95% CI, 0.58-1.30) for patients who continued dexamethasone therapy at discharge compared with those who did not. Similar results were produced by a sensitivity analysis that restricted the treatment group to those who received exactly 10 days of dexamethasone (OR, 0.89; 95% CI, 0.55-1.43) and by subgroup analyses stratified by the duration of dexamethasone treatment as an inpatient (1-3 days: OR, 0.71; 95% CI, 0.43-1.16; 4-9 days: OR, 1.01; 95% CI, 0.48-2.12), oxygen requirement at discharge (room air: OR, 0.91; 95% CI, 0.53-1.59; supplemental oxygen use: OR, 0.76; 95% CI, 0.42-1.37), and disease duration at discharge (≤10 days: OR, 0.81; 95% CI, 0.49-1.33; >10 days: OR, 0.94; 95% CI, 0.48-1.86).
Conclusions and Relevance
In this cohort study of patients with COVID-19, continuing treatment with dexamethasone, 6 mg/d, at discharge was not associated with a reduction in 14-day all-cause readmission or mortality. This finding suggests that dexamethasone should not be routinely prescribed beyond discharge for individuals with COVID-19.
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