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

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.0000000000001506

Cited by 5 publications

(6 citation statements)

References 15 publications

(40 reference statements)

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“…This network meta-analysis was based on 19 randomized controlled trials, involving 10,544 COVID-19 patients randomly assigned to nine glucocorticoids or to placebo groups. Similar to the previous meta-analysis [38,39], a moderate dose of dexamethasone (6mg/day) did reduce 28-day all-cause mortality, length of hospitalization, and the need for mechanical ventilation in patients with COVID-19. We further found that very high-dose methylprednisolone (80-200mg/day) not only reduces the above outcomes, but also has better e cacy than dexamethasone (6mg/day).…”

Section: Discussionsupporting

confidence: 78%

Efficacy and safety of glucocorticoids use in patients with COVID- 19: a systematic review and network meta‑analysis

He,

Wang,

Wang

et al. 2023

Preprint

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Background Currently, some meta-analyses on COVID-19 have suggested that glucocorticoids use can reduce the mortality rate of COVID-19 patients, utilization rate of invasive ventilation, and improve the prognosis of patients. However, optimal regimen and dosages of glucocorticoid remain unclear. Therefore, the purpose of this network meta-analysis is to analyze the efficacy and safety of glucocorticoids in treating COVID-19 at regimens. Methods This meta-analysis retrieved randomized controlled trials from the earliest records to December 30, 2022, published in PubMed, Embase, Cochrane Library, CNKI Database and Wanfang Database, which compared glucocorticoids with placebos for their efficacy and safety in the treatment of COVID-19, Effects of different treatment regimens, types and dosages (high-dose methylprednisolone, very high-dose methylprednisolone, Pulse therapy methylprednisolone, medium-dose hydrocortisone, high-dose hydrocortisone, high-dose dexamethasone, very high-dose dexamethasone and placebo) on 28-day all-caused hospitalization mortality, hospitalization duration, mechanical ventilation requirement, ICU admission and safety outcome were compared. Results In this network meta-analysis, a total of 10544patients from 19 randomized controlled trials were finally included, involving a total of 9 glucocorticoid treatment regimens of different types and dosages. According to the analysis results, the 28-day all-cause mortality rate was the lowest in the treatment with pulse therapy methylprednisolone (OR 0.08, 95% CI 0.02, 0.42), but the use of high-dose methylprednisolone (OR 0.85, 95% CI 0.59, 1.22), very high-dose dexamethasone (OR 0.95, 95% CI 0.67, 1.35), high-dose hydrocortisone (OR 0.64, 95% CI 0.34, 1.22), medium-dose hydrocortisone (OR 0.80, 95% CI 0.49, 1.31) showed no benefit in prolonging the 28-day survival of patient. Compared with placebo, the treatment with very high-dose methylprednisolone (MD= -3.09;95%CI: -4.10, -2.08) had the shortest length of hospital stay, while high-dose dexamethasone (MD= -1.55;95%CI: -3.13,0.03) and very high-dose dexamethasone (MD= -1.06;95%CI: -2.78,0.67) did not benefit patients in terms of length of stay. Conclusions Considering the available evidence, this network meta‑analysis suggests that the prognostic impact of glucocorticoids in patients with COVID-19 may depend on the regimens of glucocorticoids. It is suggested that pulse therapy methylprednisolone is associated with lower 28-day all-cause mortality, very high-dose methylprednisolone had the shortest length of hospital stay in patients with COVID-19. Trial registration: PROSPERO CRD42022350407 (22/08/2022).

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Section: Discussionsupporting

confidence: 78%

Efficacy and safety of glucocorticoids use in patients with COVID- 19: a systematic review and network meta‑analysis

He,

Wang,

Wang

et al. 2023

Preprint

View full text Add to dashboard Cite

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“…The COVID-19 SoC dexamethasone (6 mg/d) corresponds to 40 mg of prednisone (0.6 mg/kg/d of prednisone over 10 days) [ 2 ]. The efficacy of dexamethasone and methylprednisolone in COVID-19 was compared only in low-evidence studies and the results are ambiguous [ 53 ]. Furthermore, a pulse of methylprednisolone in addition to SoC dexamethasone was not beneficial in severe COVID-19 [ 54 ].…”

Section: Know Your Drug and Its Targetsmentioning

confidence: 99%

Renaissance of glucocorticoids in critical care in the era of COVID-19: ten urging questions

et al. 2022

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The 40-year-old experience with glucocorticosteroids (GCs) in the context of severe infections is complex and troublesome. Recently, however, a clear indication for GCs in severe COVID-19 has been established. This may constitute a harbinger of a wider use of GCs in critical illnesses. A fundamental prerequisite of such an action is a better understanding of the heterogeneity of critical illness and GCs operationalization within the precision medicine approach. In this perspective, we formulate ten major questions regarding the use of GCs in critical illness. Answering them will likely facilitate a new era of effective and personalized GCs use in modern critical care.

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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.…”

Section: Discussionmentioning

confidence: 99%

“…The information provided in that article was relatively incomplete and only three outcomes were analyzed. The authors of that article carried out another review [ 66 ] on non-RCTs, however, the number of included studies was relatively small. The evidence in the present study is significantly different from that in these reviews.…”

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

Cited by 5 publications

References 15 publications

Efficacy and safety of glucocorticoids use in patients with COVID- 19: a systematic review and network meta‑analysis

Efficacy and safety of glucocorticoids use in patients with COVID- 19: a systematic review and network meta‑analysis

Renaissance of glucocorticoids in critical care in the era of COVID-19: ten urging questions

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

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