Who Should Get Steroids for COVID-19?

In a recent large placebo-controlled trial, researchers demonstrated that dexamethasone lowered mortality in COVID-19 patients who were receiving mechanical ventilation or oxygen therapy. A compilation of randomized trials further suggested that patients who did not require oxygen had worse outcomes when they received corticosteroids (NEJM JW Infect Dis Nov 2020 and JAMA 2020; 324:1307). In the current meta-analysis, which includes five randomized trials and nearly 7700 patients, investigators evaluated the effect of systemic corticosteroids on survival in patients with SARS-CoV-2 infection who required various levels of respiratory support.

Mortality was significantly lower among patients who received steroids than among patients who did no…