Editor’s Note: The dosage of dexamethasone was incorrectly indicated in the original version of this article as 6 mg/kg/d. The correct dosage of dexamethasone in the comparator group was 6 mg/d.
Treatment with methylprednisolone led to significantly greater improvements in clinical status and shortened hospital length of stay than treatment with dexamethasone in hospitalized COVID-19 patients with hypoxia, according to the results of a study published in BMC Infectious Diseases.
This prospective trial included 86 hospitalized patients with COVID-19 in Iran. Participants were randomly assigned to either methylprednisolone 2 mg/kg/d (n=44) or dexamethasone 6 mg/d (n=42). Treatment was administered in conjunction with standard of care for 10 days.
The primary endpoint was 28-day mortality rate and clinical status at 5 and 10 days. The data were examined using a 9-point World Health Organization (WHO) ordinal scale ranging from uninfected (point 0) to death (point 8). Secondary endpoints included intensive care unit admission and the need for invasive mechanical ventilation.
No significant differences were observed between the treatment groups in terms of demographic variables, comorbid diseases, or disease severity at time of admission. At day 5, however, patients treated with methylprednisolone reached a significantly better clinical status compared with patients who received dexamethasone (4.02 vs 5.21, respectively; P =.002). Patients in the methylprednisolone group also had better clinical status at day 10 (2.90 vs 4.71; P =.001).
Patients in the methylprednisolone group had a significantly better overall mean 9-point WHO score (3.909 vs 4.873; P =.004). The use of methylprednisolone was also associated with a significantly shorter mean length of hospital stay (7.43±3.64 vs 10.52±5.47 days; P =.015). A lower proportion of patients in the methylprednisolone group required a ventilator during hospitalization (18.2% vs 38.1%; P =.040).
Limitations of the study included its small sample size and the lack of robust data on computer tomography features and disease-related complications.
The study investigators concluded that larger randomized trials with longer follow-up periods are needed to further examine “the beneficial effect of methylprednisolone in patients with COVID-19 pneumonia.”
Ranjbar K, Moghadami M, Mirahmadizadeh A, et al. Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC Infect Dis. 2021;21(1):337. doi:10.1186/s12879-021-06045-3