A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial.

Publication date: Nov 11, 2024

The most appropriate anti-inflammatory treatment for moderate COVID-19 pneumonia remains uncertain. We aimed to compare the effectiveness of a high-dose methylprednisolone versus a high-dose dexamethasone in hospitalized moderate COVID-19 pneumonia, regarding the WHO clinical progression scales, mortality, and the length of hospitalization. In this open-labeled randomized controlled trial, we enrolled patients with age > 18 years old who were diagnosed moderate COVID-19 pneumonia confirmed by real-time PCR, evidence of pneumonia by chest imaging and resting oxygen saturation between 90 and 94%. Patients were randomized at a 1:1 ratio to receive methylprednisolone 250 mg/day or dexamethasone 20 mg/day over the first three days. Then the patients in both groups received dexamethasone 20 mg/day on days 4-5, and 10 mg/day on days 6-10. Primary outcome was assessed by a 10-point WHO clinical progression scales ranging from uninfected (point 0) to death (point 10) on the fifth day of treatment. Secondary outcomes including 90-day mortality, length of hospitalization, rate of intensive care unit (ICU) transfer and complications were determined. Of 98 eligible patients, the mean age was 76. 0 +/- 13. 3 years. The median date of illness at the time of randomization was 3 days (interquartile range 2, 5). Baseline clinical characteristics and severity did not differ between groups. The WHO clinical progression scales were similar between methylprednisolone and dexamethasone group at 5 and 10 days of treatment [4. 84, (95% confidence interval(CI), 4. 35-5. 33) vs. 4. 76 (95% CI, 4. 27-5. 25), p = 0. 821 and 4. 32 (95% CI, 3. 83-4. 81) vs. 3. 80 (95% CI, 3. 31-4. 29), p = 0. 140, respectively)]. Both groups did not differ in-hospital mortality, length of hospitalization, and rate of ICU transfer. There were also no differences in steroid-related complications between groups until 90 days of follow-up. In patients with moderate COVID-19 pneumonia, initial anti-inflammatory treatment with 250 mg/day of methylprednisolone for three days does not yield better outcomes over high-dose dexamethasone. This study was registered at Thai Clinical Trials Registry on October 17, 2021, with the identifier TCTR20211017001.

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Concepts Keywords
October Aged
Pcr Anti-Inflammatory Agents
Pneumonia Anti-Inflammatory Agents
Steroid Corticosteroids
Tctr20211017001 COVID-19
COVID-19
COVID-19 Drug Treatment
Dexamethasone
Dexamethasone
Disease Progression
Female
Humans
Intensive Care Units
Length of Stay
Male
Methylprednisolone
Methylprednisolone
Middle Aged
Moderate pneumonia
Randomized controlled trial
SARS-CoV-2
Treatment Outcome

Semantics

Type Source Name
drug DRUGBANK Methylprednisolone
drug DRUGBANK Dexamethasone
disease MESH COVID-19
disease MESH pneumonia
disease MESH clinical progression
drug DRUGBANK Oxygen
disease MESH death
disease MESH complications
drug DRUGBANK Tropicamide
pathway REACTOME Reproduction
drug DRUGBANK Coenzyme M
disease MESH dyspnea
disease MESH critical illness
disease MESH cytokine storm
disease MESH multiple organ failures
disease MESH inflammation
drug DRUGBANK Medical air
disease MESH hypoxemia
disease MESH organizing pneumonia
disease MESH infection
disease MESH acute respiratory distress syndrome
disease IDO process
disease MESH lung injury
drug DRUGBANK Trestolone
drug DRUGBANK Ranitidine
drug DRUGBANK Coenzyme A
drug DRUGBANK Methionine
disease IDO bacteria
disease MESH end stage liver disease
disease IDO immunodeficiency
disease MESH HIV infection
pathway REACTOME HIV Infection
disease IDO cell
disease IDO history
drug DRUGBANK Prednisolone
disease IDO blood
disease MESH respiratory failure
disease MESH contraindication
disease MESH opportunistic infection
drug DRUGBANK Indoleacetic acid
disease MESH peptic ulcer perforation
disease MESH septic shock
disease MESH Obesity
disease MESH Hypertension
disease MESH Diabetes mellitus
disease MESH ESRD
disease MESH cerebrovascular accident
disease MESH chronic kidney disease
disease IDO ribonucleic acid
disease MESH Sequential organ failure assessment score
drug DRUGBANK L-Valine
drug DRUGBANK Favipiravir
drug DRUGBANK Tocilizumab
drug DRUGBANK Baricitinib
disease MESH urinary tract infection
disease MESH hyperglycemia
drug DRUGBANK Pentaerythritol tetranitrate
disease MESH viral shedding
drug DRUGBANK Iron
disease IDO symptom
disease MESH atelectasis
disease MESH Acute kidney injury
disease MESH hospital acquired pneumonia
disease MESH Infectious Diseases
drug DRUGBANK Ribostamycin
drug DRUGBANK Prednisone
disease IDO disposition
disease MESH asthma
pathway KEGG Asthma
disease MESH Allergy

Original Article

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