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Published on: August 24, 2019
Dexamethasone versus weight-adjusted methylprednisolone in patients with moderate-severe SARS-CoV-2 pneumonia
Ismael F Aomar-Millán1,2, Geoorgette Fatoul-Del Pino1, Úrsula Torres-Parejo3
1Servicio de Medicina Interna, Hospital Universitario Clínico San Cecilio, Granada, Spain.
Objectives:
To compare the 30-day outcome (mortality and/or ICU admission) of patients admitted for moderate-severe SARS-CoV-2 pneumonia treated with dexamethasone after the Recovery study versus those treated with weight-adjusted methylprednisolone.
Methods:
Retrospective cohort study of 65 patients with moderate-severe pneumonia who received dexamethasone 6 mg/day (DXM group) versus 80 treated with weight-adjusted methylprednisolone (MTPN group).
Results:
21 (32.3%) patients in the DXM group died vs 8 (10%) in the MTPN group (p-value < 0.001) and 29 (44.6%) in the DXM group required ICU admission vs 2 (2,5%) of the MTPN group (p-value <0.001). There were no baseline differences regarding sociodemographic characteristics with a higher mean qSOFA in the MTPN group. The hazard ratio for mortality and ICU admission adjusted for age, sex, and admission CRP was 2.189 (1.082-4.426; 95% CI) and 10.589 (2.139-48.347; 95% CI) for the DXM group, respectively, vs. MTPN group.
Conclusions:
Mortality and admission to the ICU were lower in patients treated with weight-adjusted methylprednisolone compared to those treated with dexamethasone.
Insights
Weight-adjusted methylprednisolone significantly reduced mortality and ICU admissions in severe SARS-CoV-2 pneumonia patients compared to dexamethasone. This finding offers critical insights for managing critical COVID-19 respiratory illness.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- The optimal corticosteroid regimen for moderate-severe SARS-CoV-2 pneumonia remains a key clinical question.
- The RECOVERY trial established dexamethasone's benefit, but subsequent studies have explored alternative agents.
- Weight-adjusted methylprednisolone is another potent corticosteroid with potential efficacy in inflammatory lung conditions.
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