RecentRCT

DexEnceph

Safety and efficacy of adjunct dexamethasone in adults with herpes simplex virus encephalitis in the UK (DexEnceph): a multicentre, observer-blind, randomised, phase 3, controlled trial.

The Lancet. Neurology, 2026 · Multicenter randomized trial

Population: 94 HSV-encephalitis adults randomized; 81 modified-ITT
Intervention: Dexamethasone plus acyclovir
Comparator: Acyclovir alone
Primary outcome: 26-week verbal memory
Result: Adjusted difference 1.77 (95% CI −9.57 to 13.12); no significant improvement. Small study with relatively late median steroid initiation.

What the trial found

Adjusted difference 1.77 (95% CI −9.57 to 13.12); no significant improvement. Small study with relatively late median steroid initiation.

Clinical interpretation

No routine efficacy established. Do not extrapolate safety to all patients or equate with bacterial-meningitis steroid evidence.

Moderate certainty

Clinical Context & Relevant Topics (1)

Disease Reference

Acute Meningitis & Encephalitis

CT-before-LP criteria, CSF interpretation matrix, de Gans Dexamethasone timing, empiric age/host antimicrobial coverage + Ampicillin + Acyclovir, and neurocritical ICP management.

View Topic Context →