A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone

Abstract

Objective The preferred agent of glucocorticoids in the treatment of patients with severe COVID-19 is still controversial. This study aimed to compare the efficacy and safety of methylprednisolone and dexamethasone in the treatment of patients with severe COVID-19. Methods By searching the electronic literature database including PubMed, Cochrane Central Register of Controlled Trials, and Web of Science, the clinical studies comparing methylprednisolone and dexamethasone in the treatment of severe COVID-19 were selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted and literature quality was assessed. The primary outcome was short-term mortality. The secondary outcomes were the rates of ICU admission and mechanical ventilation, PaO2/FiO2 ratio, plasma levels of C-reactive protein (CRP), ferritin, and neutrophil/lymphocyte ratio, hospital stay, and the incidence of severe adverse events. Statistical pooling applied the fixed or random effects model and reported as risk ratio (RR) or mean difference (MD) with the corresponding 95% confidence interval (CI). Meta-analysis was performed using Review Manager 5.1.0. Results Twelve clinical studies were eligible, including three randomized controlled trials (RCTs) and nine non-RCTs. A total of 2506 patients with COVID-19 were analyzed, of which 1242 (49.6%) received methylprednisolone and 1264 (50.4%) received dexamethasone treatment. In general, the heterogeneity across studies was significant, and the equivalent doses of methylprednisolone were higher than that of dexamethasone. Our meta-analysis showed that methylprednisolone treatment in severe COVID-19 patients was related to significantly reduced plasma ferritin and neutrophil/lymphocyte ratio compared with dexamethasone, and that no significant difference in other clinical outcomes between the two groups was found. However, subgroup analyses of RCTs demonstrated that methylprednisolone treatment was associated with reduced short-term mortality, and decreased CRP level compared with dexamethasone. Moreover, subgroup analyses observed that severe COVID-19 patients treated with a moderate dose (2 mg/kg/day) of methylprednisolone were related to a better prognosis than those treated with dexamethasone. Conclusions This study showed that compared with dexamethasone, methylprednisolone could reduce the systemic inflammatory response in severe COVID-19, and its effect was equivalent to that of dexamethasone on other clinical outcomes. It should be noted that the equivalent dose of methylprednisolone used was higher. Based on the evidence of subgroup analyses of RCTs, methylprednisolone, preferably at a moderate dose, has an advantage over dexamethasone in the treatment of patients with severe COVID-19.

Clinical characterisation, treatment outcomes, and case fatality risk of patients with different SARS-CoV-2 variants in Bangladesh

“…This reflects a better understanding of the disease and a tendency for earlier discharge during the subsequent waves. Evidence from meta-analyses and clinical trials suggests that dexamethasone reduces mortality in hospitalised COVID-19 patients on oxygen therapy or mechanical ventilation [ 20 , 41 ]. Based on the RECOVERY trial results [ 17 ], dexamethasone was the standard of care for severe or critical COVID-19 cases requiring oxygen therapy in our study hospitals.…”

Guillain‐Barré syndrome following COVID‐19 vaccination: An updated systematic review of cases

“…A diagnosis of GBS is based on a combination of clinical presentation, CSF analysis (characterized by an increased protein level without pleocytosis), and electrophysiological criteria. The chronic form of GBS is known as chronic inflammatory demyelinating polyneuropathy (CIDP) 33 ; accordingly, 10 patients had AIDP, one MFS, and one AMAN variants, while 15 patients had BFP variants of GBS (Table 3 ).…”

Comparative Efficacy of High-Dose Dexamethasone Versus Methylprednisolone in Coronavirus Disease 2019 (COVID-19)-Associated Acute Respiratory Distress Syndrome

“…This suggests that treatment with corticosteroids may improve survival in patients with ARDS of different etiologies. The existing literature suggests that MTP is effective in severe COVID-19 patients, with a usual dosage range of 1-2 mg/kg/day [18,[28][29][30]. On the other hand, there is a limited availability of comparative studies that assess the effectiveness of MTP versus DXM among mechanically ventilated COVID-19 patients.…”