Survival Outcomes in Patients With Severe COVID-19: Moderate- vs High-Dose Corticosteroids

A doctor visiting a COVID patient at the ICU.
Researchers conducted a study to determine the optimal corticosteroid dosing regimen for the treatment of patients hospitalized with severe COVID-19.

The following article is a part of conference coverage from the IDWeek 2021, being held virtually from September 29 to October 3, 2021. The team at Infectious Disease Advisor will be reporting on the latest news and research conducted by leading experts in the field. Check back for more from the IDWeek 2021.

In patients hospitalized with severe COVID-19, treatment with a moderate dose of methylprednisolone (MP) was found to be comparable with high-dose MD in increasing survival outcomes, according to research presented at IDWeek, held virtually from September 29 to October 3, 2021.

In a quasi-experimental study conducted at a single tertiary care hospital in the United States, researchers enrolled a total of 470 patients hospitalized with severe COVID-19, defined as requiring supplemental oxygen, to compare the effects of medium-dose MP (16 mg twice daily) with high-dose MP (40 mg twice daily). The primary outcome was 28-day mortality. Secondary outcomes included progression to invasive mechanical ventilation, length of hospitalization, discharge on supplemental oxygen, and corticosteroid-associated adverse events.

Overall, 218 patients were treated with high-dose MP between September and November 2020, and 252 were treated with medium-dose MP between November 2020 and January 2021. Bivariate and multivariate analyses showed no differences in mortality between the 2 treatment groups (14.7% and 13.5%; P <.712; adjusted odds ratio, 0.913 [0.514-1.619]). The median length of hospitalization among patients treated with high-dose MP and medium-dose MP was 5 and 6 days, respectively (P <.001). Compared with patients in the high-dose group, a significantly increased portion of those in the medium-dose group received treatment with oral corticosteroids; however, no differences were noted between treatment groups in regard to corticosteroid-related adverse events. Of patients treated with moderate-dose MP, there was an increased likelihood for comorbid lung disease, cardiovascular disease, and hypertension, and a decreased likelihood for prior treatment with antibiotics or toclizumab.

According to the researchers, “the survival of patients [with severe COVID-19] treated with [moderate-dose corticosteroids] is comparable with [high-dose corticosteroids].” In addition, “oral corticosteroids are an equally effective option,” the researchers concluded.

Disclosure: One author declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of disclosures. 


Joshi S, Soman S, Jain S, et al. Moderate versus high dose corticosteroids in adult patients with severe COVID-19: less is more. Presented at: IDWeek; September 29 to October 3, 2021. Poster 497.

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