Our study findings discourage the use of high doses of dexamethasone in the management of moderate to severe COVID-19 ARDS.

The routine use of such high doses to mitigate the inflammatory cytokine storm in these patients might worsen outcomes possibly due to a high rate of secondary infections and therefore cannot be recommended.

From this study, we can conclude that tocilizumab is associated with a decreased mortality, reduced need for invasive mechanical ventilation, and a higher probability of successful hospital discharge in comparison with high-dose dexamethasone when used in the context of mitigating the adverse effects of the cytokine storm.

Ventilator-free days (VFDs) were significantly lower in the HDD arm.

We stopped the trial at the first interim analysis due to high 28-day mortality in the HDD arm.

The incidence of secondary infections was also significantly high in the HDD arm (RR: 5.5; p = 0.015; NNT (harm) = 2.33).

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