COMPARATIVE EFFICACY OF METHYLPREDNISOLONE AND DEXAMETHASONE IN INTENSIVE CARE PATIENTS WITH SEVERE COVID-19: A PROSPECTIVE STUDY FROM PAKISTAN

MS HASHMI; H NAEEM; A HUSSAIN; GM ZAFAR; MA RAO; HMS JEHANGIR; HS KHOKHAR; S ZAHOOR

doi:10.54112/bcsrj.v2022i1.135

Authors

MS HASHMI Department of Internal Medicine, Services Hospital, Lahore, Pakistan
H NAEEM King Edward Medical University, Lahore
A HUSSAIN Department of Cardiology. Punjab Institute of Cardiology, Lahore, Pakistan
GM ZAFAR 4Department of Pediatric Urology. University of Child Health Science, The Children Hospital, Lahore, Pakistan.
MA RAO King Edward Medical University, Lahore
HMS JEHANGIR Department of Emergency Medicine. King Edward Medical University, Lahore, Pakistan
HS KHOKHAR King Edward Medical University, Lahore.
S ZAHOOR Department of Cardiology. Punjab Institute of Cardiology, Lahore, Pakistan

DOI:

https://doi.org/10.54112/bcsrj.v2022i1.135

Keywords:

Severe COVID-19, Dexamethasone, Methylprednisolone, Mortality

Abstract

The study aimed to determine the comparative efficacy of dexamethasone and methylprednisolone in treating severely ill COVID-19 patients in terms of mortality. Using a quasi-experimental design, the study was conducted at Mayo Hospital, Lahore, from May 2021 to October 2021. A total of 148 patients, divided into two groups of 74 each (groups A and B), were included in the study. Group A was given 6mg of dexamethasone, while group B was given methylprednisolone 40mg twice daily for 10 days. All the collected data was analyzed using SPSS 26.0, and Chi-square was used to find the mortality association between the two groups. A p-value of less than 0.05 was considered significant. The results showed that the age and gender distribution for the methylprednisolone and dexamethasone groups were 56.89±13.3 (M=36, F=38) and 57.69±12.6 (M=38, F=36), respectively. In terms of mortality, 45 patients died in the methylprednisolone group, while 54 people died in the dexamethasone group. There was statistical significance regarding mortality in both groups (p=0.003). In conclusion, the study found that administering 40mg of methylprednisolone twice daily produced better outcomes than 6mg of dexamethasone once daily in treating severe COVID-19 patients in the hospital.

Downloads

Download data is not yet available.

References

Añón, J. M., and Villar, J. (2021). Ten reasons why corticosteroid therapy reduces mortality in severe COVID-19. Intensive Care Medicine 47, 355-356.

Arabi, Y. M., Mandourah, Y., Al-Hameed, F., Sindi, A. A., Almekhlafi, G. A., Hussein, M. A., Jose, J., Pinto, R., Al-Omari, A., and Kharaba, A. (2018). Corticosteroid therapy for critically ill patients with Middle East respiratory syndrome. American journal of respiratory and critical care medicine 197, 757-767.

Budhathoki, P., Shrestha, D. B., Rawal, E., and Khadka, S. (2020). Corticosteroids in COVID-19: is it rational? A systematic review and meta-analysis. SN comprehensive clinical medicine 2, 2600-2620.

Cherkes, M., Dehgani-Mobaraki, P., and Gret, Y. (2020). ПРОТОКОЛ НАДАННЯ МЕДИЧНОЇ ДОПОМОГИ КРИТИЧНИМ ХВОРИМ НА COVID-19: клінічний випадок. Proceeding of the Shevchenko Scientific Society. Medical Sciences 62.

Corral-Gudino, L., Bahamonde, A., Arnaiz-Revillas, F., Gómez-Barquero, J., Abadía-Otero, J., García-Ibarbia, C., Mora, V., Cerezo-Hernández, A., Hernández, J. L., and López-Muñíz, G. (2020). GLUCOCOVID: A controlled trial of methylprednisolone in adults hospitalized with COVID-19 pneumonia. MedRxiv, 2020.06. 17.20133579.

Costanzo, M., De Giglio, M. A., and Roviello, G. N. (2020). SARS-CoV-2: recent reports on antiviral therapies based on lopinavir/ritonavir, darunavir/umifenovir, hydroxychloroquine, remdesivir, favipiravir and other drugs for the treatment of the new coronavirus. Current medicinal chemistry 27, 4536-4541.

Cruz-Topete, D., and Cidlowski, J. A. (2014). One hormone, two actions: anti-and pro-inflammatory effects of glucocorticoids. Neuroimmunomodulation 22, 20-32.

Darwish, I., Mubareka, S., and Liles, W. C. (2011). Immunomodulatory therapy for severe influenza. Expert review of anti-infective therapy 9, 807-822.

Edalatifard, M., Akhtari, M., Salehi, M., Naderi, Z., Jamshidi, A., Mostafaei, S., Najafizadeh, S. R., Farhadi, E., Jalili, N., and Esfahani, M. (2020). Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial. European Respiratory Journal 56.

Fadel, R., Morrison, A. R., Vahia, A., Smith, Z. R., Chaudhry, Z., Bhargava, P., Miller, J., Kenney, R. M., Alangaden, G., and Ramesh, M. S. (2020). Early short-course corticosteroids in hospitalized patients with COVID-19. Clinical Infectious Diseases 71, 2114-2120.

Farooqi, H., Firdous, S., Kazmi, S., Anwer, A., Bashir, A., and Abideen, Z. U. (2022). Elevated D-Dimer levels are strongly associated with High Mortality Rate in COVID-19 patients. An observational Study: Elevated D-Dimers in COVID-19 Patients. Pakistan BioMedical Journal, 83-89.

Lansbury, L. E., Rodrigo, C., Leonardi-Bee, J., Nguyen-Van-Tam, J., and Lim, W. S. (2020). Corticosteroids as adjunctive therapy in the treatment of influenza: an updated Cochrane systematic review and meta-analysis. Critical care medicine 48, e98-e106.

Meduri, G. U., Siemieniuk, R. A., Ness, R. A., and Seyler, S. J. (2018). Prolonged low-dose methylprednisolone treatment is highly effective in reducing duration of mechanical ventilation and mortality in patients with ARDS. Journal of Intensive Care 6, 1-7.

Ragab, D., Salah Eldin, H., Taeimah, M., Khattab, R., and Salem, R. (2020). The COVID-19 cytokine storm; what we know so far. Frontiers in immunology, 1446.

Ranjbar, K., Moghadami, M., Mirahmadizadeh, A., Fallahi, M. J., Khaloo, V., Shahriarirad, R., Erfani, A., Khodamoradi, Z., and Gholampoor Saadi, M. H. (2021). Methylprednisolone or dexamethasone, which one is superior corticosteroid in the treatment of hospitalized COVID-19 patients: a triple-blinded randomized controlled trial. BMC infectious diseases 21, 1-8.

Singhal, T. (2020). A review of coronavirus disease-2019 (COVID-19). The indian journal of pediatrics 87, 281-286.

Stern, A., Skalsky, K., Avni, T., Carrara, E., Leibovici, L., and Paul, M. (2017). Corticosteroids for pneumonia. Cochrane Database of Systematic Reviews.

Villar, J., Ferrando, C., Martínez, D., Ambrós, A., Muñoz, T., Soler, J. A., Aguilar, G., Alba, F., González-Higueras, E., and Conesa, L. A. (2020). Dexamethasone treatment for the acute respiratory distress syndrome: a multicentre, randomised controlled trial. The Lancet Respiratory Medicine 8, 267-276.

Wang, Y., Jiang, W., He, Q., Wang, C., Wang, B., Zhou, P., Dong, N., and Tong, Q. (2020a). A retrospective cohort study of methylprednisolone therapy in severe patients with COVID-19 pneumonia. Signal transduction and targeted therapy 5, 57.

Wang, Y., Zhang, D., Du, G., Du, R., Zhao, J., Jin, Y., Fu, S., Gao, L., Cheng, Z., and Lu, Q. (2020b). Remdesivir in adults with severe COVID-19: a randomised, double-blind, placebo-controlled, multicentre trial. The lancet 395, 1569-1578.

Wilkinson, E. (2020). RECOVERY trial: the UK covid-19 study resetting expectations for clinical trials. Bmj 369.

Williams, D. M. (2018). Clinical pharmacology of corticosteroids. Respiratory care 63, 655-670.