Abstract
Background: In the first half of 2020 COVID-19 disease has already converted into a global pandemic. Various treatment options were being tried all over the globe. Corticosteroids have been considered in medication since long times and they are extensively endorsed.
Objective: Various treatment therapies were being tried all over the globe to curb the COVID-19 disease. As studies showed encouraged effects of corticosteroids in COVID-19 pandemic, hence we conducted this study to compare the efficacy and safety of low doses of methylprednisolone and dexamethasone in moderate to severe COVID-19 symptoms.
Methods: A study on 300 patients, 150 patients in group A who received dexamethasone and 150 patients in group B who received methylprednisolone was conducted in the department of Aneasthesiology and critical care pain management in Govt; Medical collage Srinagar (J&K) over the period of six months. Group A received 8mg BD dexamethasone and group B received methylprednisolone 1mg/kg/day in 2 divided doses for 8 days during their stay in our ICU. The remaining treatment was the same in both the groups including anticoagulants and antibiotics. We revived the following parameters after 8 days, serum ferritin levels and CRP levels among the study population.
Results: The initial mean serum ferritin levels of group A decreases after administration of dexamethasone. Similarly the initial ferritin levels of group B also decreased after administration of methylprednisolone. Same results were obtained for CRP levels in both the groups. However, dexamethasone was significantly more effective than methylprednisolone (p<0.05).
Conclusion: steroids are an effective tool in the treatment of COVID-19 due to their ability to suppress the immune response along with their anti-inflammatory properties. In the treatment of COVID-19 patients, use of dexamethasone can lead to a further decrease in mortality as compared to methylprednisolone.
Keywords: Methylprednisolone, Dexamethasone, COVID-19, pneumonia.
References
- Guo Y-R, CaoQ-D,Hong Z-S et al. The origin, transmission and clinical therapies on coronavirus disease 2019 (COVID-19) outbreak: an update on the status. Med. Res. 7(1), 1–10 (2020).
- Guan W, Ni Z, Hu Y et al. Clinical characteristics of coronavirus disease 2019 in China. Engl. J. Med. 382(18), 1708–1720 (2020).
- Li X, Ma X. Acute respiratory failure in COVID-19: is it “typical” ARDS? Care 24(1), 198 (2020).
- DeDiego ML, Nieto-Torres JL, Regla-Nava JA et al. Inhibition of NF-κB-mediated inflammation in severe acute respiratory syndrome coronavirus-infected mice increases survival. Virol. 88(2), 913–924 (2014).
- Chan JF-W, Yao Y, Yeung M-L et al. Treatment with lopinavir/ritonavir or interferon-β1b improves outcome of MERS-CoV infection in a nonhuman primate model of common marmoset. Infect. Dis. 212(12), 1904–1913 (2015).
- Arabi YM, Mandourah Y, Al-Hameed F et al. Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome. J. Respir. Crit. Care Med. 197(6), 757–767 (2018). 7. Stockman LJ, Bellamy R, Garner P. SARS: systematic review of treatment effects. PLoS Med. 3(9), e343 (2006).
- Cascella, M. Rajnik, A. Cuomo, S.C. Dulebohn, R. Di Napoli, Features, evaluation, and treatment of coronavirus (COVID-19), in: StatPearls. Treasure Island (FL), StatPearls Publishing, 2020. August 10.
- Wang, W. Jiang, Q. He, et al., A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia, Sig Transduct Target Ther 5 (2020) 57, https://doi.org/10.1038/s41392-020-0158-2.
- Ye, Y. Wang, L.E. Colunga-Lozano, et al., Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis, CMAJ (Can. Med. Assoc. J.) 192 (27) (2020).
- Zhang, Y. Zhao, F. Zhang, et al., The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): the Perspectives of clinical immunologists from China, Clin. Immunol. 214 (2020) 108393, https://doi.org/10.1016/j.clim.2020.108393
- Fadel, A. Morrison, A. Vahia, Z. Smith, Z. Chaudhry, P. Bhargava, et al., Early Short-Course Corticosteroids in Hospitalized Patients with COVID-19, Clinical Infectious Diseases, 2020.
- Coronavirus Disease 2019 (COVID-19), Centers for Disease Control and Prevention, 2020 [cited 29 August 2020].
- Wang, C. Wu, Q. Zhang, et al., C-reactive protein level may predict the risk of COVID-19 aggravation, Open Forum Infect Dis 7 (5) (2020), https://doi.org/ 10.1093/ofid/ofaa153 ofaa153. Published 2020 Apr 29.
- Wilkinson, RECOVERY trial: the UK COVID-19 study resetting expectations for clinical trials, BMJ (2020) m1626.
- Zhang JJY, Lee KS, Ang LW, Leo YS, Young BE. Risk factors of severe disease and efficacy of treatment in patients infected with COVID-19: a systematic review, meta-analysis and meta-regression analysis. Infect. Dis. doi: 10.1093/cid/ciaa576 (2020).
- Veronese N, Demurtas J, Yang L et al. Use of corticosteroids in coronavirus disease 2019 pneumonia: a systematic review of the literature. Med. 7(April), 1–6 (2020).
- Gong Y, Guan L, Jin Z, Chen S, Xiang G, Gao B. Effects of methylprednisolone use on viral genomic nucleic acid negative conversion and CT imaging lesion absorption in COVID-19 patients under 50 years old. Med. Virol. doi: 10.1002/jmv.26052 (2020).
- Fang X, Mei Q, Yang T et al. Low-dose corticosteroid therapy does not delay viral clearance in patients with COVID-19. Infect. 81(1), 147–178 (2020).
- Selvaraj V, Dapaah-Afriyie K, Finn A, Flanigan TP. Short-term dexamethasone in Sars-CoV-2 patients. I. Med. J. (2013) 103(6), 39–43 (2020).
- Li S, Hu Z, Song X. High-dose but not low-dose corticosteroids potentially delay viral shedding of patients with COVID-19. Infect. Dis. doi: 10.1093/cid/ciaa829 (2020) (Epub ahead of print).
- Yuan M, Xu X, Xia D et al. Effects of corticosteroid treatment for non-severe COVID-19 pneumonia: a propensity score-based analysis. Shock doi:10.1097/ 0000000000001574 (2020).
- The RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with COVID-19: preliminary report. N. Engl. J. Med. doi:10.1056/NEJMoa2021436 (2020).
Corresponding Author
Dr Shazia Ashraf
Senior Resident, Department of Anesthesiology & Critical Care, Govt. Medical College, Srinagar, India
DOI: https://dx.doi.org/10.18535/jmscr/v9i5.21
