# Do corticosteroids reduce mortality in severe COVID-19?

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**Summary:** Yes — in patients requiring oxygen or ventilation. There was no benefit, and possible harm, in those needing no respiratory support.

The RECOVERY trial randomised 6,425 hospitalised patients with COVID-19 to dexamethasone 6 mg daily for up to 10 days or usual care. Mortality at 28 days was lower with dexamethasone among patients receiving invasive mechanical ventilation and among those receiving oxygen without ventilation [1].

Crucially, the benefit tracked severity: among patients receiving no respiratory support at randomisation, there was no benefit, and the point estimate raised the possibility of harm [1]. Corticosteroid treatment in COVID-19 is therefore indicated by oxygen requirement rather than by diagnosis alone.

A WHO-coordinated prospective meta-analysis of 7 randomised trials in critically ill patients (1,703 participants across dexamethasone, hydrocortisone, and methylprednisolone) found lower 28-day all-cause mortality with systemic corticosteroids, supporting a class effect in the critically ill [2].

## Limitations

- Benefit is confined to patients requiring respiratory support; extending treatment to milder disease is not supported and may cause harm.
- Trials were conducted before widespread vaccination and before later variants, so absolute mortality figures do not reflect current baseline risk.

## Sources

1. [IV / Randomised trial] Dexamethasone in Hospitalized Patients with Covid-19. New England Journal of Medicine (2021). PMID 32678530. https://pubmed.ncbi.nlm.nih.gov/32678530/
2. [III / Systematic review] Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA (2020). PMID 32876694. https://pubmed.ncbi.nlm.nih.gov/32876694/

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