Comparison of Efficacy of Dexamethasone and Methylprednisolone in Improving PaO2/FiO2 Ratio Among COVID-19 Patients

Abstract

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the reason for the global pandemic that started from Wuhan, China, in December 2019, known as coronavirus diseases 2019 (COVID-19). Acute respiratory distress syndrome happened in COVID-19 not just because of uncontrolled viral replication but also because of an uncontrolled immune reaction from the host. That's why antiviral and anti-inflammatory treatments have become an increasing concern for clinicians. Methods A retrospective quasi-experimental study design was used to assess the effectiveness of methylprednisolone and dexamethasone in the improvement of PaO 2 /FiO 2 (P/F) ratio in COVID-19 patients. We included 60 participants for this study by using a convenient sampling technique and divided them into two groups with 30 patients in each group. Group 1 was given dexamethasone 8 mg twice daily, and group 1 given methylprednisolone 40 mg twice daily for eight days. We recorded C-reactive protein (CRP), serum ferritin level, and P/F ratio before administration of both drugs and after administration of drugs for eight days. We used the paired t-test to assess the effect of both drugs on the P/F ratio of participants. Results The initial mean CRP in group 1 was 110.34, which reduced to 19.45 after administration of dexamethasone; similarly, the CRP in group 2 was 108.65, which reduced to 43.82 after administering methylprednisolone for eight days. In P/F ratio improvement, the calculated significance value for dexamethasone (p=0.000) was less than the table value at 0.05 in all sections, p-value for methylprednisolone (p=0.009) was also less than the table value at 0.05, which shows that both dexamethasone and methylprednisolone were effective in improving P/F ratio. Calculated p-value for dexamethasone (p=0.000) was lower than the calculated p-value for methylprednisolone (p=0.009), which shows that dexamethasone is more effective as compare to methylprednisolone. Conclusions Steroid therapy is effective in controlling inflammation markers, and especially dexamethasone is significantly effective in improving the P/F ratio in COVID-19 patients.

Tenofovir-DF versus Hydroxychloroquine in the Treatment of Hospitalized Patients with COVID-19: An Observational Study (TEDHICOV)

“…At the beginning of the outbreak in Arequipa (March-April 2020), Hydroxychloroquine with or without lopinavir / ritonavir or azithromycin was used as a standard treatment and according to the best evidence at that time as a therapy against SARS-CoV-2 according to national guidelines [1] and the medical literature available [2][3][4][5][6][7][8][9][10][11][12][13][14][15][16].…”

“…Regarding agents with direct action against the virus, initial hopes focused on remdesivir, Hydroxychloroquine, lopinavir / ritonavir and interferon-β. Of these agents, only remdesivir appears to have any favorable action against COVID-19 [4][5][6][7][8][9][10]. In contrast, various studies have shown the lack of efficacy of the other schemes [11][12][13][14][15][16][17][18][19][20].…”

“…Table No. 6 shows the results of the multiple linear regression model for the LOS variable in all patients. There are statistically significant differences only for TDF use and sex.…”

Beware of Steroid-Induced Avascular Necrosis of the Femoral Head in the Treatment of COVID-19—Experience and Lessons from the SARS Epidemic

“… The early-stage use of a combination of favipiravir and methylprednisolone in severe cases can achieve a favorable clinical outcome 25 Alejandro Rodríguez-Molinero/Spain Cohort study 418 Steroids/No steroids 65.4 56.9% COVID- 19 patients with pulmonary involvement 6 (8.1%)/10(13.2%) Methylprednisolone 1 mg/kg/day or dexamethasone 20–40 mg/day The mortality can not been analysed due to the low number of events. There is no benefit in the use of glucocorticoids in terms of lung function or time to discharge 26 Yan Hu/China Single-center study 308 Steroids/No steroids 54 (44–63)/48 (39–60) 47.2%/46.7% COVID- 19 patients with pulmonary involvement None Equivalent of methylprednisolone 0.75–1.5 mg/kg/d) Glucocorticoid therapy did not significantly influence the clinical course, adverse events nor the outcome of COVID-19 pneumonia 27 Muhammad A. Rana/PAK Retrospective quasi-experimental study 60 Dexamethasone/Methylprednisolone 53.8/53.9 66.7%/70% Patients treated in HDU/ICU and had been on bi-level positive airway pressure. Not mentioned Dexamethasone 8 mg BID/Methylprednisolone 40 mg BID; 8 days Dexamethasone is more effective in improving the P/F ratio in COVID-19 patients compared to methylprednisolone 28 Marla J Keller/UAS Observational study 1806 Steroids/No steroids 61.7 ± 15.9/62.3 ± 17.9 49.3%/46.3% COVID-19 patients Glucocorticoid increased mortality of patients with CRP< 10 mg/dL Early glucocorticoids (within 48 hours of admission) Choosing the right patients is critical to maximize the likelihood of benefit and minimize the risk of harm 29 Hong-Ming Z...…”

COVID-19 and Rheumatic Diseases: It Is Time to Better Understand This Association

“…Although the studies that evaluated the use of HCQ have not demonstrated its effectiveness as a protective or therapeutic agent 21 , its use also seems to have no association with worse outcomes 22,23 . Some studies using CS in the acute phase of COVID-19 have also shown their effectiveness in controlling inflammation markers, particularly in cases of ARDS 24,25 . Thus, the association of worse outcomes with intrahospital use of CS and HCQ could be related to its use in more severe patients, perhaps late, in an attempt to improve the patient's condition, when there was little knowledge about the treatment of COVID-19.…”