[BostonCard]

I trained giving our big surgery postops 8mg dex q8 hours x 3. And I prescribe plenty of high dose prednisone in routine outpatient practice these days. There are risks with high dose steroids but most patients tolerate well so I think with the favorable side effect profile, we will see them prescribed very commonly now for covid patients, even as outpatients. They'll probably make patients feel a little better anyway.

And I think there is benefit in trying to keep the immune system from going into overdrive before you get bad lung disease. Personally, if I get it bad enough to land in the hospital, one of the first things I'm asking the ER doc for is a slug of dex.

The study is available in preprint here:

https://www.medrxiv.org/content/10.1101/...20137273v1

If you look at figure 2, the Forest plot, you see that among the patients who started out not on oxygen, not only does dexamethasone not improve survival, it may worsen it (though confidence intervals don't exclude no effect at all).  And there is some plausability behind that, since early in the disease you are worried about viral replication more than cytokine storm and dex is immunosupressive.

So, I would definitely not give it to outpatients.  But once it gets bad enough to require admission and oxygen, I would probably move in with the dex.

BC

[BostonCard]

I trained giving our big surgery postops 8mg dex q8 hours x 3. And I prescribe plenty of high dose prednisone in routine outpatient practice these days. There are risks with high dose steroids but most patients tolerate well so I think with the favorable side effect profile, we will see them prescribed very commonly now for covid patients, even as outpatients. They'll probably make patients feel a little better anyway.

And I think there is benefit in trying to keep the immune system from going into overdrive before you get bad lung disease. Personally, if I get it bad enough to land in the hospital, one of the first things I'm asking the ER doc for is a slug of dex.

The study is available in preprint here:

https://www.medrxiv.org/content/10.1101/...20137273v1

If you look at figure 2, the Forest plot, you see that among the patients who started out not on oxygen, not only does dexamethasone not improve survival, it may worsen it (though confidence intervals don't exclude no effect at all).  And there is some plausability behind that, since early in the disease you are worried about viral replication more than cytokine storm and dex is immunosupressive.

So, I would definitely not give it to outpatients.  But once it gets bad enough to require admission and oxygen, I would probably move in with the dex.

BC