High‐dose methylprednisolone in nonintubated patients with severe COVID‐19 pneumonia

Abstract

Background Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID‐19). Data on methylprednisolone are limited. Methods Retrospective cohort of consecutive adults with severe COVID‐19 pneumonia on high‐flow oxygen (FiO2 ≥ 50%) admitted to an academic centre in New York, from 1 March to 15 April 2020. We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resource utilization. Results Of 447 patients, 153 (34.2%) received methylprednisolone and 294 (65.8%) received no corticosteroids. At 28 days, 102 patients (22.8%) had died and 115 (25.7%) received mechanical ventilation. In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0.63; 95% CI 0.47‐0.86; P = .003), driven by less frequent mechanical ventilation (subhazard ratio 0.56; 95% CI 0.40‐0.79; P = .001); mortality did not differ between groups. The methylprednisolone group had 2.8 more ventilator‐free days (95% CI 0.5‐5.1; P = .017) and 2.6 more intensive care‐free days (95% CI 0.2‐4.9; P = .033) during the first 28 days. Complication rates were not higher with methylprednisolone. Conclusions In nonintubated patients with severe COVID‐19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less‐intensive care resource utilization without excess complications.

A short course of corticosteroids reduces the risk of mechanical ventilation and death in patients with moderate to severe COVID 19 pneumonia: results of a retrospective monocentric cohort

“…In a single-centre, real-life population receiving the same standard of care, our findings confirmed the efficacy of corticosteroids in reducing the risk of mechanical ventilation or death in patients with moderate to severe COVID-19 pneumonia. These results were in line with those of previous cohort studies [ 9 , 10 , 17 , 18 ] and a large randomized trial [ 11 ] where corticosteroids were included in the standard of care for COVID-19 pneumonia. Corticosteroid therapy was also beneficial in older and comorbid patients who were not eligible for intensive care.…”

Methylprednisolone or Dexamethasone, Which One Is the Superior Corticosteroid in the Treatment of Hospitalized COVID-19 Patients: A Triple-Blinded Randomized Controlled Trial

“…Since there had been con icting results in other viral pneumonia regarding the safety and bene cial effects of corticosteroids, the world health organization (WHO) in the early period of the pandemic published recommendations against the routine use of these agents in managing patients with COVID-19 (26). However, it is well known that glucocorticoid agents are thought to be useful in stopping the in ammatory storm by suppressing pro-in ammatory gene expression and decreasing cytokine levels if used at the appropriate time in the disease course (34).…”

“…Mechanistically, methylprednisolone achieves higher lung tissue-to-plasma ratios in animal models than dexamethasone, which may thus be more effective for lung injury (24). Also, previous studies have shown the effectiveness of methylprednisolone on treating SARS disease (25,26). Hence, we hypothesized that methylprednisolone could be more effective than other corticosteroids, particularly dexamethasone.…”

Heart–lung interactions in COVID-19: prognostic impact and usefulness of bedside echocardiography for monitoring of the right ventricle involvement

“…In an early study, all hospitalized COVID-19 patients had pneumonia confirmed by chest CT. [ 7 ]. In large study, 48.8% of hospitalized patients had severe pneumonia requiring high-flow O 2 therapy [ 8 ]. Adults admitted to emergency departments with suspected COVID-19 that were subsequently confirmed were more than twice as likely to die or receive organ support as those who did not have COVID-19 confirmed, despite having similar age and comorbidities (expect chronic lung disease) [ 9 ].…”