Methylprednisolone May Be Superior to Dexamethasone in COVID-19: A Meta-Analysis of Randomized Controlled Trials

Beran, Azizullah; Ayesh, Hazem; Mhanna, Mohammed; Srour, Omar; Musallam, Rami; Sayeh, Wasef; Khokher, Waleed; Altorok, Nehaya; Noori, Z.; Assaly, Ragheb; Altorok, Nezam

doi:10.1097/mjt.0000000000001507

Cited by 7 publications

(9 citation statements)

References 15 publications

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“…Although there are no comparative data on the effect of these GC types on the development of CAPA, several studies in literature support the superiority of non‐dexamethasone regimens including methylprednisolone/prednisolone over dexamethasone. A meta‐analysis of three randomized controlled trials reported significantly fewer adverse events, including hyperglycaemia and secondary infections, in non‐dexamethasone GC‐treated COVID‐19 patients than in dexamethasone‐treated COVID‐19 patients 60 . An in vitro study reported that dexamethasone inhibits microbial phagocytic activity of neutrophils, while an equivalent dose of methylprednisolone does not have such adverse effects, indicating a reduced risk of infection with the use of this non‐dexamethasone GC 61 .…”

Section: Discussionmentioning

confidence: 94%

“…Our results showed that dexa- dexamethasone-treated COVID-19 patients. 60 An in vitro study reported that dexamethasone inhibits microbial phagocytic activity of neutrophils, while an equivalent dose of methylprednisolone does not have such adverse effects, indicating a reduced risk of infection with the use of this non-dexamethasone GC. 61 The treatment of COVID-19 patients with methylprednisolone compared to dexamethasone has been shown to have a shorter length of ICU stay and fewer episodes of nosocomial sepsis.…”

Section: Ta B L E 2 (Continued)mentioning

confidence: 95%

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Effect of glucocorticoids on the development of COVID‐19‐associated pulmonary aspergillosis: A meta‐analysis of 21 studies and 5174 patients

Hashim

Nath

Khan

et al. 2023

Mycoses

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COVID‐19‐associated pulmonary aspergillosis (CAPA) remains a high mortality mycotic infection throughout the pandemic, and glucocorticoids (GC) may be its root cause. Our aim was to evaluate the effect of systemic GC treatment on the development of CAPA. We systematically searched the PubMed, Google Scholar, Scopus and Embase databases to collect eligible studies published until 31 December 2022. The pooled outcome of CAPA development was calculated as the log odds ratio (LOR) with 95% confidence intervals (CI) using a random effect model. A total of 21 studies with 5174 patients were included. Of these, 20 studies with 4675 patients consisting of 2565 treated with GC but without other immunomodulators (GC group) and 2110 treated without GC or other immunomodulators (controls) were analysed. The pooled LOR of CAPA development was higher for the GC group than for the controls (0.54; 95% CI: 0.22, 0.86; p < .01). In the subgroups, the pooled LOR was higher for high‐dose GC (0.90; 95% CI: 0.17, 1.62: p = .01) and dexamethasone (0.71; 95% CI: 0.35, 1.07; p < .01) but had no significant difference for low‐dose GC (0.41; 95% CI: −0.07, 0.89; p = .09), and non‐dexamethasone GC (0.21; 95% CI: −0.36, 0.79; p = .47), treated patients versus controls. GC treatment increases the risk of CAPA development, and this risk is particularly associated with the use of high‐dose GC or dexamethasone treatment.

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Section: Discussionmentioning

confidence: 94%

Section: Ta B L E 2 (Continued)mentioning

confidence: 95%

Effect of glucocorticoids on the development of COVID‐19‐associated pulmonary aspergillosis: A meta‐analysis of 21 studies and 5174 patients

Hashim

Nath

Khan

et al. 2023

Mycoses

View full text Add to dashboard Cite

show abstract

“…A meta-analysis of three randomized controlled trials reported significantly fewer adverse events, including hyperglycemia and secondary infections, in nondexamethasone GC-treated COVID-19 patients than in dexamethasone-treated COVID-19 patients. 61 An in vitro study reported that dexamethasone inhibits the phagocytic bactericidal activity of neutrophils, while an equivalent dose of methylprednisolone does not have such adverse effects, indicating a diminished risk of infection with the use of this nondexamethasone GC. 62 The treatment of COVID-19 patients with methylprednisolone compared to dexamethasone has been shown to have a shorter length of ICU stay and fewer episodes of nosocomial sepsis.…”

Section: Discussionmentioning

confidence: 99%

Effect of Glucocorticoids on the Development of COVID-19-Associated Pulmonary Aspergillosis: A Meta-Analysis of 21 Studies and 4972 Patients

et al. 2023

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“…Coincidentally, some systematic reviews [ 64 – 66 ] on the same topic have been published recently. One review [ 65 ] published in the form of "Letters" also included the three RCTs analyzed in our study. The information provided in that article was relatively incomplete and only three outcomes were analyzed.…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone

Hong

Wang

et al. 2023

BMC Infect Dis

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Objective The preferred agent of glucocorticoids in the treatment of patients with severe COVID-19 is still controversial. This study aimed to compare the efficacy and safety of methylprednisolone and dexamethasone in the treatment of patients with severe COVID-19. Methods By searching the electronic literature database including PubMed, Cochrane Central Register of Controlled Trials, and Web of Science, the clinical studies comparing methylprednisolone and dexamethasone in the treatment of severe COVID-19 were selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted and literature quality was assessed. The primary outcome was short-term mortality. The secondary outcomes were the rates of ICU admission and mechanical ventilation, PaO2/FiO2 ratio, plasma levels of C-reactive protein (CRP), ferritin, and neutrophil/lymphocyte ratio, hospital stay, and the incidence of severe adverse events. Statistical pooling applied the fixed or random effects model and reported as risk ratio (RR) or mean difference (MD) with the corresponding 95% confidence interval (CI). Meta-analysis was performed using Review Manager 5.1.0. Results Twelve clinical studies were eligible, including three randomized controlled trials (RCTs) and nine non-RCTs. A total of 2506 patients with COVID-19 were analyzed, of which 1242 (49.6%) received methylprednisolone and 1264 (50.4%) received dexamethasone treatment. In general, the heterogeneity across studies was significant, and the equivalent doses of methylprednisolone were higher than that of dexamethasone. Our meta-analysis showed that methylprednisolone treatment in severe COVID-19 patients was related to significantly reduced plasma ferritin and neutrophil/lymphocyte ratio compared with dexamethasone, and that no significant difference in other clinical outcomes between the two groups was found. However, subgroup analyses of RCTs demonstrated that methylprednisolone treatment was associated with reduced short-term mortality, and decreased CRP level compared with dexamethasone. Moreover, subgroup analyses observed that severe COVID-19 patients treated with a moderate dose (2 mg/kg/day) of methylprednisolone were related to a better prognosis than those treated with dexamethasone. Conclusions This study showed that compared with dexamethasone, methylprednisolone could reduce the systemic inflammatory response in severe COVID-19, and its effect was equivalent to that of dexamethasone on other clinical outcomes. It should be noted that the equivalent dose of methylprednisolone used was higher. Based on the evidence of subgroup analyses of RCTs, methylprednisolone, preferably at a moderate dose, has an advantage over dexamethasone in the treatment of patients with severe COVID-19.

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Methylprednisolone May Be Superior to Dexamethasone in COVID-19: A Meta-Analysis of Randomized Controlled Trials

Cited by 7 publications

References 15 publications

Effect of glucocorticoids on the development of COVID‐19‐associated pulmonary aspergillosis: A meta‐analysis of 21 studies and 5174 patients

Effect of glucocorticoids on the development of COVID‐19‐associated pulmonary aspergillosis: A meta‐analysis of 21 studies and 5174 patients

Effect of Glucocorticoids on the Development of COVID-19-Associated Pulmonary Aspergillosis: A Meta-Analysis of 21 Studies and 4972 Patients

A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone

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