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Category: Volume 09 Issue 05 May 2021
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Title: Role of methylprednisolone versus Dexamethasone in COVID-19 Pneumonia: A comparative study

Authors: Kouser Benazir, Nayla Farooq, Shazia Ashraf

 DOI: https://dx.doi.org/10.18535/jmscr/v9i5.21

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

  1. 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).
  2. Guan W, Ni Z, Hu Y et al. Clinical characteristics of coronavirus disease 2019 in China. Engl. J. Med. 382(18), 1708–1720 (2020).
  3. Li X, Ma X. Acute respiratory failure in COVID-19: is it “typical” ARDS? Care 24(1), 198 (2020).
  4. 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).
  5. 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).
  6. 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).
  7. 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.
  8. 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.
  9. 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).
  10. 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
  11. 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.
  12. Coronavirus Disease 2019 (COVID-19), Centers for Disease Control and Prevention, 2020 [cited 29 August 2020].
  13. 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.
  14. Wilkinson, RECOVERY trial: the UK COVID-19 study resetting expectations for clinical trials, BMJ (2020) m1626.
  15. 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).
  16. 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).
  17. 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).
  18. 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).
  19. 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).
  20. 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).
  21. 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).
  22. 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