Dexamethasone Not Favored for Chronic Subdural Hematoma

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Dexamethasone worse than placebo with respect to favorable outcome at six months

WEDNESDAY, Dec. 30, 2020 (HealthDay News) — Dexamethasone results in fewer favorable outcomes than placebo among patients with symptomatic chronic subdural hematoma, according to a study published online Dec. 16 in the New England Journal of Medicine.

Peter J. Hutchinson, Ph.D., from the University of Cambridge in the United Kingdom, and colleagues conducted a multicenter, randomized trial in the United Kingdom to examine the effect of dexamethasone in patients with symptomatic chronic subdural hematoma. Patients were randomly assigned to either a two-week tapering course of oral dexamethasone starting at 8 mg twice daily or placebo in a 1:1 ratio (375 and 373 patients, respectively).

During the index admission, 94 percent of participants underwent surgery to evacuate their hematomas. The researchers found that in a modified intention-to-treat analysis that included 680 patients, a favorable outcome on the modified Rankin scale at six months after randomization was reported for 83.9 percent of 341 patients in the dexamethasone group and in 90.3 percent of the 339 patients in the placebo group (difference, −6.4 percentage points in favor of the placebo group). Repeat surgery for hematoma recurrence was performed in 1.7 and 7.1 percent of patients in the dexamethasone and placebo groups, respectively. There were more adverse events reported in the dexamethasone group versus the placebo group.

“The results of this trial reduce the enthusiasm for treating chronic subdural hematomas with glucocorticoids,” writes the author of an accompanying editorial.

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