Dexamethasone vs Methylprednisolone in Patients Hospitalized With COVID-19

Compared with methylprednisolone, treatment with dexamethasone was more effective and decreased the length of hospitalization in patients with COVID-19 infection, according to results of a randomized clinical trial published in the International Journal of Infectious Diseases.

Researchers conducted a study between April and June 2021 to compare the effects of dexamethasone with methylprednisolone among patients (N=143) younger than 80 years hospitalized with reverse transcription polymerase chain reaction-confirmed COVID-19 infection. Patients were randomly assigned to receive either intravenous dexamethasone 8 mg daily or intravenous methylprednisolone 60 mg daily. The patients were observed throughout hospitalization and for up to 28 days following discharge. The primary outcome was the length of hospitalization; secondary outcomes included absolute leukocyte and lymphocyte counts at baseline and at hospital discharge, incident hypokalemia and hyperglycemia, the need for intensive care unit (ICU) admission, duration of oxygen therapy, and mortality within 28 days of hospital admission. Mann-Whitney, chi-square, and t-tests were used to analyze the results.

There were 73 patients in the methylprednisolone group and 70 in the dexamethasone group, of whom the mean age was 61.74 64.51 years, 53.4% and 58.6% were men, 27.4% and 24.3% had diabetes, and 50.7% and 44.3% had hypertension, respectively.

The researchers found that the median length of hospitalization was significantly increased among patients who received methylprednisolone vs those who received dexamethasone (11 [IQR, 7-14] vs 8 [IQR, 6-10] days; P <.001). Further analysis showed that the median duration of oxygen therapy also was significantly increased among patients in the methylprednisolone group (10 vs 7 days; P =.001). No statistically significant differences between the 2 patient groups were noted in regard to ICU admission and leukocyte and lymphocyte counts at hospital discharge.

The incidence of both hypokalemia (24.7% vs 78.1%) and hyperglycemia (11.4% vs 36.8%) was increased among patients who received methylprednisolone vs those who received dexamethasone (both P <.05). Although the rate of mortality was increased among patients in the dexamethasone group compared with those in the methylprednisolone group (17.1% vs 12.3%, respectively), the difference was not statistically significant.

This study was limited by the lack of a control group, the small sample size, and the lack of blinding among the health care providers involved in the study.

“…similar studies [should] be performed with a large sample size and different doses of the two drugs to achieve more conclusive results,” the researchers concluded.

Reference

Dastenae ZH, Bahadori A, Dehghani M, Asadi-Samani M, Izadi I, Shahraki HR. Comparison of the effect of intravenous dexamethasone and methylprednisolone on the treatment of hospitalized patients with COVID-19: a randomized clinical trial. Int J Infect Dis. July 8, 2022. doi:10.1016/j.ijid.2022.07.019