Treatment of subdural hematoma with dexamethasone led to fewer favorable outcomes compared with placebo, according to research published in The New England Journal of Medicine.
Symptomatic chronic subdural hematoma is a common neurological disorder among older adults. Surgical evacuation is the primary treatment option, but recurrence still occurs in approximately 10% to 20% of patients.
A team of investigators conducted a randomized, placebo-controlled trial to evaluate a tapering 2-week course of dexamethasone. The multicenter trial enrolled patients who were aged 18 years or older with symptomatic chronic subdural hematoma. A favorable outcome was defined as a score of 0 to 3 on the modified Rankin scale at 6 months.
A total of 748 patients were randomly assigned to either dexamethasone (n=375) or placebo (n=373). At baseline, nearly 60% of patients in both groups had a modified Rankin scale score of 1 to 3. During the trial period, 94.2% of enrolled patients underwent surgical evacuation of the hematoma.
At 6 months, favorable outcomes were noted in 83.9% of patients in the dexamethasone and 90.3% of patients in the placebo group (P =0.01). Favorable outcomes were also more frequent in the placebo group at a 3-month analysis.
Repeat surgery for hematoma recurrence was noted in 1.7% of patients in the dexamethasone group and 7.1% of patients in the placebo group. Because most patients underwent surgery to treat the hematoma, the authors were unable to conclude whether dexamethasone could help avoid surgery.
Adverse events were more common in the dexamethasone group, with 10.9% of patients experiencing adverse events of special interest compared with 3.2% in the placebo group; 16% of patients in the dexamethasone group experienced serious adverse events compared with 6.4% in the placebo group. The risk of infection was also higher in the dexamethasone group.
After 6 months, 87% of patients had a modified Rankin scale score of 0 to 3. The Rankin scores were lower for patients receiving dexamethasone, and adverse events were higher; however, the percentage of patients who underwent repeated surgeries for recurrence was less in the dexamethasone group compared with the placebo group.
Overall, treatment with dexamethasone did not improve functional outcomes for patients with subdural hematoma.
Disclosure: Some authors have declared affiliations with or received grant support from the pharmaceutical industry. Please refer to the original study for a full list of disclosures.
Hutchinson PJ, Edlmann E, Bulters D, et al. Trial of dexamethasone for chronic subdural hematoma. N Engl J Med. 2020;383(27):2616-2627. doi:10.1056/NEJMoa2020473