920: Methylprednisolone Versus Dexamethasone for Covid-Induced Acute Respiratory Distress Syndrome

Abstract

INTRODUCTION:The COVID-19 pandemic has led to devastating outcomes, especially among patients who progress to Acute Respiratory Distress Syndrome (ARDS). Corticosteroids improve survival and ventilator-free days in hospitalized patients with COVID-19 pneumonia requiring supplemental oxygen therapy. Though currently dexamethasone (DEX) is a first line corticosteroid due to its longer half-life and relative lack of mineralocorticoid activity, it is unclear whether alternate corticosteroids can demonstrate similar benefit. Historically, methylprednisolone (MP) has been the default treatment for pre-COVID ARDS and has shown benefit in severe Community Acquired Pneumonia due to its' high lung tissue penetration. Given increasing incidence of ARDS observed in severe COVID pneumonia, the goal of our study is to compare efficacy of MP vs DEX in moderate to severe ARDS. METHODS:This is a single center, multi-location, retrospective, observational study of 575 adult patients admitted to OSF Hospitals between 02/01/2020 and 03/31/2021 for treatment of confirmed COVID-19 pneumonia and moderate to severe ARDS defined as PaO2:FiO2< 200. Patients were grouped based on steroid regimen into one of three treatment arms: those receiving at least 6 mg of DEX (N=360) or 30 mg of MP (N=136) as single or divided daily dose, or sequential use of both DEX+MP (N=79). Demographic data, symptoms, laboratory values, steroid dosing and clinical outcomes were collected. RESULTS:The three treatment groups were similar in terms of baseline CRP, SAPS scores and procalcitonin levels. There was no difference in 28-day all-cause mortality rate among the three groups. The DEX+MP group demonstrated higher in-hospital mortality rate compared to either DEX or MP alone (60.8% vs 41.7% and 44.1%, respectively, p=0.008). The DEX+MP combination group had longer duration of stay compared to DEX or MP alone (21 days vs 12 and 13 days, respectively, p< 0.001) and spent more days in the ICU (14 days vs 6.5 and 7 days, respectively, p< 0.001). CONCLUSIONS:We did not observe 28-day mortality lowering effect across any of the three treatment groups. Dexamethasone was associated with reduced ICU and total hospital length of stay. A prospective, randomized trial comparing DEX and MP is warranted to further investigate potential superiority.