Dexamethasone at discharge for COVID-19 does not reduce readmission, mortality
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Continued use of dexamethasone after hospital discharge was not associated with a reduction in readmission or mortality among patients with COVID-19, researchers reported in JAMA Network Open.
Cheng-Wei Huang, MD, a physician at Kaiser Permanente Los Angeles Medical Center, and colleagues conducted a retrospective cohort study at 15 medical centers within Kaiser Permanente’s Southern California locations.
They enrolled 1,164 adults aged 18 years or older who were discharged after being hospitalized for COVID-19 between May 1 and Sept. 30, 2020. All participants received less than 10 days of dexamethasone, 6 mg per day, until discharge.
All participants were discharged after June 16. Their median age was 55 years (interquartile range [IQR], 44-66), and the majority were men (57.9%). The median duration of inpatient dexamethasone was 4 days (IQR, 3-6).
Overall, 692 patients (59.5%) continued dexamethasone after discharge for a median of 5 days (IQR, 4-7). The median total of days using dexamethasone for these participants was 10 (IQR, 10-11).
Among these patients, 9.1% were either readmitted or died within the next 14 days, at a median time of 3 days (IQR, 2-5) after discharge, compared with 11.4% of patients who did not continue dexamethasone.
Following inverse probability of treatment weighting, the adjusted OR of 14-day readmission or mortality for patients who continued dexamethasone use was 0.87 (95% CI, 0.58-1.3) compared with those who did not continue use.
“Although our study was done early in the pandemic, our findings remain of relevance in today’s practice, especially because corticosteroids have become a cornerstone therapy for COVID-19,” the authors wrote. “We believe that a negative study finding early in the pandemic would apply even more so today, because poor outcomes are less likely with better understanding of the disease, increased levels of vaccination, and variants that result in diseases with lower acuity.”
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