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A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of
Jakkrit Laikitmongkhon1, Tanapat Tassaneyasin2, Yuda Sutherasan3
1Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol University, 270 Rama VI Road, Ratchathewi, Bangkok, 10400, Thailand.
Background:
The most appropriate anti-inflammatory treatment for moderate COVID-19 pneumonia remains uncertain. We aimed to compare the effectiveness of a high-dose methylprednisolone versus a high-dose dexamethasone in hospitalized moderate COVID-19 pneumonia, regarding the WHO clinical progression scales, mortality, and the length of hospitalization.
Methods:
In this open-labeled randomized controlled trial, we enrolled patients with age > 18 years old who were diagnosed moderate COVID-19 pneumonia confirmed by real-time PCR, evidence of pneumonia by chest imaging and resting oxygen saturation between 90 and 94%. Patients were randomized at a 1:1 ratio to receive methylprednisolone 250 mg/day or dexamethasone 20 mg/day over the first three days. Then the patients in both groups received dexamethasone 20 mg/day on days 4-5, and 10 mg/day on days 6-10. Primary outcome was assessed by a 10-point WHO clinical progression scales ranging from uninfected (point 0) to death (point 10) on the fifth day of treatment. Secondary outcomes including 90-day mortality, length of hospitalization, rate of intensive care unit (ICU) transfer and complications were determined.
Results:
Of 98 eligible patients, the mean age was 76.0 ± 13.3 years. The median date of illness at the time of randomization was 3 days (interquartile range 2, 5). Baseline clinical characteristics and severity did not differ between groups. The WHO clinical progression scales were similar between methylprednisolone and dexamethasone group at 5 and 10 days of treatment [4.84, (95% confidence interval(CI), 4.35-5.33) vs. 4.76 (95% CI, 4.27-5.25), p = 0.821 and 4.32 (95% CI, 3.83-4.81) vs. 3.80 (95% CI, 3.31-4.29), p = 0.140, respectively)]. Both groups did not differ in-hospital mortality, length of hospitalization, and rate of ICU transfer. There were also no differences in steroid-related complications between groups until 90 days of follow-up.
Conclusions:
In patients with moderate COVID-19 pneumonia, initial anti-inflammatory treatment with 250 mg/day of methylprednisolone for three days does not yield better outcomes over high-dose dexamethasone.
Trial Registration:
This study was registered at Thai Clinical Trials Registry on October 17, 2021, with the identifier TCTR20211017001.
Insights
High-dose methylprednisolone did not show better outcomes than dexamethasone for moderate COVID-19 pneumonia. Both treatments resulted in similar WHO clinical progression scales, mortality, and hospitalization length.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pulmonology
Background:
- Optimal anti-inflammatory therapy for moderate COVID-19 pneumonia is not well-established.
- This study compares high-dose methylprednisolone and dexamethasone in hospitalized patients.
Purpose of the Study:
- To compare the effectiveness of methylprednisolone versus dexamethasone in moderate COVID-19 pneumonia.
- Outcomes assessed include WHO clinical progression scales, mortality, and hospitalization duration.
Main Methods:
- Open-labeled randomized controlled trial involving patients with moderate COVID-19 pneumonia.
- Patients received either methylprednisolone (250 mg/day) or dexamethasone (20 mg/day) for three days, followed by a tapering dose regimen.
- Primary outcome was WHO clinical progression scale on day 5; secondary outcomes included 90-day mortality and ICU transfer.
Main Results:
- No significant difference in WHO clinical progression scales at days 5 and 10 between methylprednisolone and dexamethasone groups.
- In-hospital mortality, length of hospitalization, and ICU transfer rates were similar between the two treatment arms.
- No significant differences in steroid-related complications were observed up to 90 days.
Conclusions:
- Initial high-dose methylprednisolone (250 mg/day for 3 days) does not offer superior outcomes compared to high-dose dexamethasone in moderate COVID-19 pneumonia.
- Both treatments demonstrated comparable efficacy and safety profiles in this patient cohort.
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