High dose methylprednisolone bests dexamethasone for hospitalized COVID-19 patients: Study
Colombia: Methylprednisolone is better than dexamethasone for the treatment of hospitalized patients with severe Covid-19 Pneumonia, according to a recent study in PLOS One.
The study found that the treatment with high-dose methylprednisolone for three days followed by oral prednisone for 14 days versus 6 mg dexamethasone for 7 to 10 days significantly decreased the need for transfer to ICU, recovery time, and the severity markers C-reactive protein (CRP), D-dimer and LDH.
Till now there is no effective treatment of severe acute respiratory syndrome by coronavirus 2 (SARS-CoV2) responsible for the coronavirus disease (COVID-19). Dexamethasone has shown to decrease mortality in patients requiring oxygen, especially those with mechanical ventilation. However, it is not known if another corticosteroid can be used to achieve a better clinical outcome.
Against the above background, Miguel Alejandro Pinzón, Department of Infectious Diseases, Clínica Medellín, Grupo Quirónsalud, Medellín, Antioquia, Colombia, and colleagues aimed to compare the differences in clinical outcome and laboratory results in hospitalized patients with severe SARS-CoV2 Pneumonia treated with dexamethasone at 6 mg doses versus patients treated with high-dose methylprednisolone.
For this purpose, the researchers conducted an ambispective cohort study with survival analysis of patients diagnosed with severe Covid-19 pneumonia. The patients should also have supplementary oxygen and radiological confirmation of Pneumonia by chest tomography.
111 patients were treated with the institutional protocol with intravenous dexamethasone 6 mg QD for seven to 10 days if they required oxygen. Since September 15, 2020, the hospitalization protocol of the clinic was modified by the Infectious Diseases and Pulmonology service, recommending a high dose of methylprednisolone of 250 to 500 mg every day for three days with a subsequent change to oral prednisone 50 mg every day for 14 days. The protocol was not applied in the intensive care unit, where dexamethasone continued to be administered.
The researchers then evaluated the clinical outcome and differences in laboratory results of the patients who received dexamethasone vs. the prospective cohort that received methylprednisolone from September 15 to October 31, 2020. Follow-up was carried out by outpatient consultation one month after discharge or by telephone, inquiring about readmission or living-dead status.
Key findings of the study include:
- 216 patients had Covid-19 pneumonia documented by ground-glass imaging and alveolar pressure / inspired oxygen fraction (PaFi) less than 300. 111 patients received dexamethasone (DXM) and 105 received methylprednisolone (MTP).
- · Patients in the DXM group evolved to severe ARDS in a higher proportion (26.1% vs 17.1% than the MTP group).
- · Upon completion 4 days of treatment with parenteral corticosteroid, laboratory markers of severity decreased significantly in the group that received MTP, CRP 2.85 vs 7.2, D-dimer 691 vs 1083 and DHL 273 vs 355.
- · After starting the corticosteroid, transfer to the intensive care unit (4.8% vs. 14.4%) and mortality (9.5% vs. 17.1%) was lower in the group that received MTP.
- · Recovery time was shorter in patients treated with MTP, three days vs. DXM 6 days.
- · At 30-day follow-up, 92.6% were alive in MTP vs 63.1% of those who received dexamethasone.
"Randomized controlled studies with methylprednisolone are required to corroborate its effect, and studies in a population hospitalized in intensive care wards," wrote the authors.
The study titled, "Dexamethasone vs methylprednisolone high dose for Covid-19 pneumonia," is published in the journal PLOS One.