RECOVERY (dexamethasone): what the trial showed
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. Results are summarized from the cited trial report and any companion publications listed below.
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 | Usual care alone | Effect |
|---|---|---|
| 22.9% (482 of 2,104) | 25.7% (1,110 of 4,321) | 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
Written for healthcare professionals as an orientation to the primary publication, not as a substitute for reading it. For literature search, education, and professional evidence review only. Not for diagnosis, treatment selection, triage, monitoring, prognosis, or patient-specific clinical decision-making.