Methylprednisolone Compared to Dexamethasone for the Treatment of Hospitalized Covid-19 Patients

ABSTRACT

INTRODUCTION: Coronavirus disease 2019 (COVID-19) has led to significant morbidity and mortality worldwide. Corticosteroids have been shown to reduce mortality in hospitalized COVID-19 patients requiring supplemental oxygen. Current guidelines recommend dexamethasone (DEX);however, some studies suggest methylprednisolone (MP) may reduce hospital length of stay (HLOS) compared to DEX. The purpose of this study was to compare the efficacy and safety of MP and DEX in hospitalized COVID-19 patients. METHOD(S) A retrospective, single-center study evaluated adult patients with confirmed SARS-CoV-2 infection that received at least one dose of MP or DEX during their hospital admission from 3/1/2020 to 9/28/2021. The primary outcome was HLOS. Secondary outcomes included duration of mechanical ventilation (MV), intensive care unit length of stay (ICU LOS), inpatient mortality, incidence of hyperglycemia, nosocomial infection, and gastrointestinal bleeding. A sample size calculation indicated 49 patients per group would detect a 3-day reduction in HLOS in those given MP (alpha=0.05, power=0.8). Data are reported as percentage, median (IQR), or OR (95% CI). RESULT(S) 230 patients were included (100 patients in MP, 130 patients in DEX). Differences in demographics included ICU admission (80% vs. 56.9%;p=0.0002), invasive ventilation (52% vs. 30.8%;p=0.002), vasopressor use (53% vs. 30%;p=0.001), renal replacement therapy (27% vs. 10%;p=0.001), ARDS diagnosis (78% vs. 52.3%;p=0.001), and intermediate intensity anticoagulation (8% vs. 17.7%;p=0.034) for MP and DEX groups, respectively. Patients given MP had longer HLOS (17.8 days [9.3, 26.6] vs. 8.9 days [4.4, 16.2];p< 0.001), ICU LOS (13 days [5.6, 22.5] vs. 8.2 days [3.9, 14.1];p=0.017), and higher mortality (42% vs. 24.6%;p=0.007). Nosocomial infection (41% vs. 26.9%;p=0.034) and gastrointestinal bleeding (10% vs. 2.3%;p=0.019) occurred more frequently in the MP group. There were no differences in duration of MV or hyperglycemia. MP was associated with longer HLOS after multivariate analysis that adjusted for ICU admission, adverse effects, ARDS diagnosis, and anticoagulation (OR 2.76 [95% CI 1.18-6.4];p=0.019). CONCLUSION(S) MP was associated with increased HLOS, increased ICU LOS, higher mortality, and higher incidence of adverse effects compared to DEX.