In this trial, the adjusted point estimate for 28-day mortality was 4.5 percentage points lower in the 12 mg of dexamethasone group than in the 6 mg of dexamethasone group, but it did not reach a statistical significance. The study did not show a statistical difference in primary or secondary outcome measures. However, the study included patients with severe hypoxemia requiring 10 L/m of oxygen or higher, a level of oxygen that is arbitrarily selected and Bayesian analysis was not used compared to both RECOVERY and REMAP-CAP trials. Also, following these patients for total of 180 days may provide additional information. Of note, there is a planned prospective meta-analysis of the trials assessing high-dose vs standard-dose dexamethasone in patients with COVID-19 and hypoxemia. I think until more data is available, 6 mg of dexamethasone remains the standard in all patients with COVID-19 pneumonia excluding those patients with suspected organizing pneumonitis.
The COVID STEROID 2 Trial Group. Effect of 12 mg vs 6 mg of Dexamethasone on the Number of Days Alive Without Life Support in Adults With COVID-19 and Severe Hypoxemia: The COVID STEROID 2 Randomized Trial. JAMA. Published online October 21, 2021. doi:10.1001/jama.2021.18295