Affiliation:
1. Division of Hospital Medicine, University of Tsukuba Hospital, Tsukuba, Japan.
2. Department of Health Services Research, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
3. Division of Cardiology, Montefiore Medical Center, Albert Einstein College of Medicine, New York, NY.
4. Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA.
5. Department of Medicine, Icahn School of Medicine at Mount Sinai, Mount Sinai Beth Israel, New York, NY.
6. Department of Emergency and Critical Care Medicine, Tsukuba Memorial Hospital, Tsukuba, Japan.
7. Department of Non-Communicable Disease Epidemiology, Faculty of Epidemiology and Population Health, London School of Hygiene and Tropical Medicine, London, United Kingdom.
Abstract
IMPORTANCE:
Although pulse (high-dose) methylprednisolone therapy can hypothetically control immune system flare-ups effectively, the clinical benefit of pulse methylprednisolone compared with dexamethasone in COVID-19 remains inconclusive.
OBJECTIVES:
To compare pulse methylprednisolone to dexamethasone as a COVID-19 treatment.
DESIGN, SETTING, AND PARTICIPANTS:
Using a Japanese multicenter database, we identified adult patients admitted for COVID-19 and discharged between January 2020 and December 2021 treated with pulse methylprednisolone (250, 500, or 1,000 mg/d) or IV dexamethasone (≥ 6 mg/d) at admission day 0 or 1.
Main Outcomes and Measures:
The primary outcome was in-hospital mortality. Secondary outcomes were 30-day mortality, new ICU admission, insulin initiation, fungal infection, and readmission. Multivariable logistic regression was conducted to differentiate the dose of pulse methylprednisolone (250, 500, or 1,000 mg/d). Additionally, subgroup analyses by characteristics such as the need for invasive mechanical ventilation (IMV) were also conducted.
RESULTS:
A total of 7,519, 197, 399, and 1,046 patients received dexamethasone, 250, 500, and 1,000 mg/d of methylprednisolone, respectively. The crude in-hospital mortality was 9.3% (702/7,519), 8.6% (17/197), 17.0% (68/399), and 16.2% (169/1,046) for the different doses, respectively. The adjusted odds ratio (95% CI) was 1.26 (0.69–2.29), 1.48 (1.07–2.04), and 1.75 (1.40–2.19) in patients starting 250, 500, and 1,000 mg/d of methylprednisolone, respectively, compared with those starting dexamethasone. In subgroup analyses, the adjusted odds ratio of in-hospital mortality was 0.78 (0.25–2.47), 1.12 (0.55–2.27), and 1.04 (0.68–1.57) in 250, 500, and 1,000 mg/d of methylprednisolone, respectively, among patients with IMV, whereas the adjusted odds ratio was 1.54 (0.77–3.08), 1.62 (1.13–2.34), and 2.14 (1.64–2.80) among patients without IMV.
CONCLUSIONS AND RELEVANCE:
Higher doses of pulse methylprednisolone (500 or 1,000 mg/d) may be associated with worse COVID-19 outcomes when compared with dexamethasone, especially in patients not on IMV.
Publisher
Ovid Technologies (Wolters Kluwer Health)
Subject
Critical Care and Intensive Care Medicine