Efficacy and Safety Comparison of Two Different Doses of Dexamethasone in Hospitalized Patients with COVID-19: A Randomized Clinical Trial.

Objective: The current study aims to investigate high- versus low-dose dexamethasone administration to control the disease with minor complications.

Methods: The current multicentric randomized clinical trial was conducted on 119 patients with COVID-19 pneumonia and assigned into two groups of low-dose (8 mg daily intravenous dose for at least 7 days or until discharge) ( = 61) versus high-dose dexamethasone (24 mg for 3 days followed by daily 8 mg for the at least 4 days later or until discharge) ( = 58) during 2020-2021. Oxygen saturation, dyspnea severity based on the Borg scale, and laboratory indices were assessed at 3, 5, and 7 days of corticosteroid therapy. Patients were compared regarding the length of hospitalization, intensive care unit (ICU) admission requirement, and noninvasive or invasive ventilation. The other investigations included corticosteroid-related adverse effects and mortality rates within a month after the medications.

Findings: Oxygen saturation, Borg scale, and C-reactive protein levels were significantly altered by the time in both the groups ( < 0.05). In contrast, the trend of improvements in Borg scale ( = 0.007) and lactate dehydrogenase levels ( = 0.034) were superior in high-dose treated cases. Drug-related adverse ( = 0.809), mortality rate ( = 0.612), hospitalization duration ( = 0.312), ICU admission requirement ( = 0.483), and noninvasive ( = 0.396) and invasive ventilation ( = 0.420) did not differ between the groups.

Conclusion: According to this study, low- versus high-dose dexamethasone therapy did not affect the outcomes, so low-dose dexamethasone is recommended for COVID-19 pneumonia to achieve optimal results and prevent potential adverse events.