Dexamethasone or methylprednisolone therapy in covid-19 pneumonia: A retrospective and comparative study of 513 cases

Abstract

Backgrounds Corona virus disease 19 (Covid-19) affects especially the respiratory tract, and induces lung injury which may progress to the acute respiratory distress syndrome (ARDS). Various treatment options were tried all over the world, corticosteroids had showed beneficial effects. The Objective of this study, is to compare the safety and efficiency of two corticosteroids: dexamethasone and prednisolone in the treatment of Covid-19 infection. Methods This retrospective and comparative study included 513 patients diagnosed with Covid-19 infection and were admitted to intensive care unit of our university hospital center of MOHAMMED VI Oujda from 1 st March 2020, to December 31st , 2020. Results In this study, 513 cases were included, 230 patients were received methylprednisolone, and 283 were treated with dexamethasone. The median age in methylprednisolone group was 64 years, and 63 years in the second group treated with dexamethasone. Patients treated with dexamethasone had more critically lesions compared to patients treated with methylprednisolone (67.6%), these patients had a good evolution with a significant reduction of oxygen supplementation, lower use of invasive ventilation and a significant improvement in biological parameters. The difference in outcome between the two groups in terms of mortality was significantly reduced in the second group. Conclusion Both steroids are efficient in the management of mild, moderate and severe Covid-19 pneumonia with a clear superiority of dexamethasone especially in severe forms.

Methylprednisolone Versus Dexamethasone in COVID-19: A Meta-Analysis of Nonrandomized Studies

“…Six nonrandomized studies 3,5,8,9,12,13 with a total of 1282 patients (622 patients received MP and 660 received DEXA) were included. Characteristics and quality assessment of the included studies are summarized in Table 1.…”

“…Statistically similar results were obtained for mortality after sequentially excluding each study in all meta-analyses, suggesting the results were robust. Removal of the study by El Mezzeoui et al 9 resulted in I 2 = 15% without significant changes in the overall, suggesting that the study by El Mezzeoui et al was partly the reason for the significant between-study heterogeneity.…”

“…Five studies reported mortality rate. 3,5,8,9,13 The mortality rate was 26.8% in the MP group compared with 30.5% in the DEXA group. No significant difference was found in mortality between the 2 groups (RR 1.00, 95% CI 0.76–1.30, P = 0.98, I 2 = 51%, Figure 1A).…”

“…Across the 4 studies 3,5,9,13 that reported the need for intubation, 30.1% of patients who received MP required intubation compared with 30.06% in patients who received DEXA. The need for intubation was similar between MP and DEXA groups (RR 1.03, 95% CI 0.70–1.52, P = 0.88, I 2 = 72%, Figure 2B).…”

Pulse versus nonpulse steroid regimens in patients with coronavirus disease 2019: A systematic review and meta‐analysis

“…[14][15][16] Several studies have compared PDS versus nonpulse dose steroids (NPDS) with conflicting results. 14,[17][18][19] Data regarding the role of PDS in COVID-19 are still unclear.…”