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The new england journal of medicine established in 1812 February 25, 2021 vol. 384 no. 8 Dexamethasone in Hospitalized Patients with Covid-19 The RECOVERY Collaborative Group* abstract BACKGROUND Coronavirus disease 2019 (Covid-19) is associated with diffuse lung damage. Gluco- The members of the writing committee corticoids may modulate inflammation-mediated lung injury and thereby reduce F.R.C.P., Jonathan R. Emberson, Ph.D., progression to respiratory failure and death. Marion Mafham, M.D., Jennifer L. Bell, M.Sc., Louise Linsell, D.Phil., Natalie METHODS Staplin, Ph.D., Christopher Brightling, In this controlled, open-label trial comparing a range of possible treatments F.Med.Sci., Andrew Ustianowski, Ph.D., in patients who were hospitalized with Covid-19, we randomly assigned patients to Einas Elmahi, M.Phil., Benjamin Prudon, F.R.C.P., Christopher Green, D.Phil., Tim- receive oral or intravenous dexamethasone (at a dose of 6 mg once daily) for up othy Felton, Ph.D., David Chadwick, to 10 days or to receive usual care alone. The primary outcome was 28-day mortality. Ph.D., Kanchan Rege, F.R.C.Path., Chris- Here, we report the final results of this assessment. topher Fegan, M.D., Lucy C. Chappell, Ph.D., Saul N. Faust, F.R.C.P.C.H.,Thomas RESULTS gomery, Ph.D., Kathryn Rowan, Ph.D., Ed-Mont- A total of 2104 patients were assigned to receive dexamethasone and 4321 to re- mund Juszczak, M.Sc., J. Kenneth Baillie, M.D., Ph.D., Richard Haynes, D.M., and ceive usual care. Overall, 482 patients (22.9%) in the dexamethasone group and Martin J. Landray, F.R.C.P.) assume re- 1110 patients (25.7%) in the usual care group died within 28 days after randomiza- sponsibility for the overall content and tion (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; integrity of this article. P<0.001). The proportional and absolute between-group differences in mortality varied considerably according to the level of respiratory support that the patients writing committeeare listedin theAppen- dix.AddressreprintrequeststoDrs.Horby were receiving at the time of randomization. In the dexamethasone group, the and Landray at RECOVERY Central Coor- incidence of death was lower than that in the usual care group among patients dinating Office, Richard Doll Bldg., Old receiving invasive mechanical ventilation (29.3% vs. 41.4%; rate ratio, 0.64; 95% Road Campus, Roosevelt Dr., Oxford OX3 CI, 0.51 to 0.81) and among those receiving oxygen without invasive mechanical 7LF, United Kingdom, or at recoverytrial@ ndph.ox.ac.uk. ventilation (23.3% vs. 26.2%; rate ratio, 0.82; 95% CI, 0.72 to 0.94) but not among *A complete list of collaborators in the those who were receiving no respiratory support at randomization (17.8% vs. 14.0%; RECOVERY trial is provided in the Supple- rate ratio, 1.19; 95% CI, 0.92 to 1.55). mentary Appendix, available at NEJM.org. CONCLUSIONS Drs. Horby, Lim, and Emberson and Drs. In patients hospitalized with Covid-19, the use of dexamethasone resulted in Haynes and Landray contributed equally lower 28-day mortality among those who were receiving either invasive mechanical to this article. A preliminary version of this article was ventilation or oxygen alone at randomization but not among those receiving no published on July 17, 2020, at NEJM.org. respiratory support. (Funded by the Medical Research Council and National In- stitute for Health Research and others; RECOVERY ClinicalTrials.gov number, N Engl J Med 2021;384:693-704. NCT04381936; ISRCTN number, 50189673.) Copyright © 2020 Massachusetts Medical Society. 693 n engl j med 384;8 nejm.org February 25, 2021 The New England Journal of Medicine Downloaded from nejm.org on October 18, 2023. For personal use only. No other uses without permission. Copyright © 2021 Massachusetts Medical Society. All rights reserved.