Glucocorticoid dose in COVID-19: Lessons for clinical trials during a pandemic


Steven A Webb, Alisa M Higgins, Colin J McArthur

JAMA Editorial, 2021;326(18):1801–1802. DOI:

The ongoing COVID-19 pandemic necessitates an urgent need for rapid and yet methodologically rigorous clinical trials to identify the optimal combination of safe and effective treatments as well as rapid identification of candidate treatments that are harmful or ineffective. This need is particularly acute for treatments suitable for use in resource-limited settings, which require interventions that are widely available and inexpensive.

To date, few COVID-19 treatments have been shown to be effective in improving outcomes. Systemic glucocorticoids have been demonstrated to improve survival when administered to patients who are moderately or severely ill,1,2 and are recommended in both the World Health Organization (WHO) guidance for the clinical management of COVID-19 and the National Institutes of Health COVID-19 treatment guidelines.3,4 Although the WHO guidance does not recommend a particular glucocorticoid dose, the National Institutes of Health guidelines recommend 6 mg of dexamethasone once daily for 10 days or until hospital discharge for hospitalized adults requiring supplemental oxygen or mechanical ventilation.

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