# RECOVERY (dexamethasone): what the trial showed

Canonical page: https://cliniatlas.com/trials/recovery-dexamethasone/

In 6,425 hospitalised COVID-19 patients, dexamethasone 6 mg daily for up to 10 days reduced 28-day mortality from 25.7% to 22.9%, with the benefit concentrated in patients on invasive ventilation or oxygen and no benefit, possibly harm, in those needing no respiratory support.

**Main cited publication:** Dexamethasone in Hospitalized Patients with Covid-19. New England Journal of Medicine (2021). PMID 32678530. https://pubmed.ncbi.nlm.nih.gov/32678530/

## At a glance

- Design: Randomised, controlled, open-label, adaptive platform trial (dexamethasone arm)
- Population: 6,425 patients hospitalised with COVID-19 in the UK: 2,104 assigned to dexamethasone and 4,321 to usual care
- Intervention: Dexamethasone 6 mg once daily, oral or intravenous, for up to 10 days
- Comparator: Usual care alone
- Follow-up: 28 days
- Registration: NCT04381936; ISRCTN50189673
- Funding: UK Medical Research Council, National Institute for Health Research, and others

## Primary outcome

All-cause mortality at 28 days.

- Dexamethasone 6 mg once daily, oral or intravenous, for up to 10 days: 22.9% (482 of 2,104)
- Usual care alone: 25.7% (1,110 of 4,321)
- Effect: Age-adjusted rate ratio 0.83 (95% CI 0.75 to 0.93), P<0.001

## Key findings

- In patients on invasive mechanical ventilation, mortality was 29.3% versus 41.4% (rate ratio 0.64, 95% CI 0.51 to 0.81).
- In patients receiving oxygen without invasive ventilation, mortality was 23.3% versus 26.2% (rate ratio 0.82, 95% CI 0.72 to 0.94).
- In patients receiving no respiratory support at randomisation, mortality was 17.8% versus 14.0% (rate ratio 1.19, 95% CI 0.92 to 1.55): no benefit, with a point estimate towards harm.
- The result changed practice worldwide within weeks and was the first treatment shown to reduce COVID-19 mortality.

## Harms and safety

- The primary publication reports the mortality signal in patients without respiratory support rather than a detailed adverse event profile; hyperglycaemia and secondary infection are the recognised concerns with glucocorticoids.

## Limitations

- Open-label, with mortality as a robust endpoint that limits bias.
- Conducted early in the pandemic, before vaccination and antivirals, in a UK hospital population.
- The subgroup by respiratory support drives the recommendation, and the no-oxygen subgroup was smaller.

## Where it sits in guidelines

The WHO living guideline (September 2020) strongly recommends systemic corticosteroids for patients with severe or critical COVID-19 and recommends against them in non-severe disease, drawing on RECOVERY and the WHO REACT prospective meta-analysis of seven trials.

## CliniAtlas answers that use this trial

- https://cliniatlas.com/evidence/corticosteroids-severe-covid-19-mortality/

Ask about this trial against live sources (free, no sign-in): https://cliniatlas.com/?q=What%20did%20the%20RECOVERY%20(dexamethasone)%20trial%20show%20and%20how%20should%20it%20be%20interpreted%3F

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