A Comparison of Methylprednisolone and Dexamethasone in Intensive Care Patients with COVID-19

Abstract

OBJECTIVES: This study retrospectively compares the effectiveness of methylprednisolone to dexamethasone in patients with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2 or COVID-19) requiring ICU care. DESIGN: This is an institutional review board approved cohort study in patients with COVID-19 requiring intensive care unit admission. Patients admitted and requiring oxygen supplementation were treated with either methylprednisolone or dexamethasone. SETTING: This study takes place in the intensive care units at a large, tertiary, public teaching hospital serving a primarily low-income community in urban Los Angeles. PATIENTS: All eligible patients admitted to the intensive care unit for COVID-19 respiratory failure from March 1 to July 31, 2020 were included in this study. INTERVENTIONS: A total of 262 patients were grouped as receiving usual care (n=75), methylprednisolone dosed at least at 1mg/kg/day for ≥ 3 days (n=104), or dexamethasone dosed at least at 6 mg for ≥ 7 days (n=83). MEASUREMENTS and MAIN RESULTS: All-cause mortality within 50 days of initial corticosteroid treatment as compared to usual care was calculated. The mortality effect was then stratified based on levels of respiratory support received by the patient. In this cohort of 262 patients with severe COVID-19, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days (p <0.01) respectively. In patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235-0.956, p=0.0385). CONCLUSIONS: In COVID-19 patients requiring mechanical ventilation, sufficiently dosed methylprednisolone can lead to a further decreased mortality as compared to dexamethasone.

Therapeutic Agents Rounding Up the Immunopathology of COVID-19

“…In this study, all-cause mortalities in the usual care, methylprednisolone, and dexamethasone groups were 41.3%, 16.4% and 26.5% at 50 days ( P < 0.01) respectively. 45 It was found that in patients requiring mechanical ventilation, mortality was 42% lower in the methylprednisolone group than in the dexamethasone group (hazard ratio 0.48, 95% CI: 0.235–0.956, P = 0.0385).…”

“…19 to Jun. 8, 2020), n=6425 6 mg (oral or intravenous once daily) 28-day mortality Dexamethasone: 482 of 2104 (22.9%) vs Control: 1110 of 4321 (25.7%) (p<0.001) Methylprednisolone Dexamethasone Ko JJ et al, 2021, 45 USA Cohort study (Mar. 1 to Jul.…”

Therapeutic Application of Corticosteroids in COVID‐19: A Focus on Optimum Dose and Duration of Therapy

“…In some cases, clinical pharmacology properties of corticosteroids have been ignored, which could lead to misleading data. [10][11][12] For example, Ranjbar et al 10 carried out a prospective triple-blinded RCT to compare the effectiveness of methylprednisolone (2 mg/kg/d and tapered to half dosage every 5 days [intervention group]) with the RECOVERY trial dose of dexamethasone (6 mg/d for 10 days [control group]) in 86 hospitalized adult patients with COVID-19. They concluded that methylprednisolone (2 mg/kg/d) is superior to dexamethasone (6 mg/d) in decreasing need for mechanical ventilation (18.2% vs 38.1%; P = .040), hospital length of stay (7.43 ± 3.64 vs 10.52 ± 5.47; P = .015), and improving clinical status at days 5 (4.02 vs 5.21; P = .002) and 10 (2.90 vs 4.71; P = .001).…”

“…It is important to mention that the dose of corticosteroid in the methylprednisolone group was higher in Ko and colleagues' study than the National Institutes of Health panel recommendation; however, according to the previous evidence on the potential beneficial efficacy of high doses of corticosteroids in the treatment of classic ARDS, the evaluation effects of 1 mg/kg of methylprednisolone seems to be rational in patients with severe COVID-19. 9,11,14,15 Pinzón et al, 12 in an ambispective cohort study in 216 patients with severe COVID-19 pneumonia showed that high-dose methylprednisolone (250-500 mg/d for 3 days) followed by oral prednisone (50 mg daily) for 14 days leads to statistically significant lower recovery time (P < .0001), C-reactive protein (P < .0001), d-dimer (P = .04), and lactate dehydrogenase (P = .01) compared with dexamethasone (6 mg/d for 10 days). Moreover, in Pinzón and colleagues' study, the rate of mortality and intensive care unit admission were lower in the methylprednisolone group compared with the dexamethasone group (4.8% vs 14.4%; 9.5% vs 17.1%).…”

“…Notably, the regimens of the medicines are approximate according to the equivalent doses and duration of action corticosteroids: dexamethasone 0.75 mg (half-life, 36-72 hours), prednisolone 5 mg (half-life, 8-12 hours), methylprednisolone 4 mg (half-life, 12-36 hours), and hydrocortisone 20 mg (half-life, 12-36 hours). [10][11][12][13][14][15] Several clinical trials are ongoing to answer the important clinical questions about exact dose, treatment duration, time of administration, and using additional medicines with immunomodulatory properties in different clinical situations of patients with COVID-19. In critical conditions like the present pandemic, the concerning issues around the study design of the trials and subsequent misleading results could lead to inappropriate treatment strategies and harm to patients.…”