As compared to dexamethasone, the use of high-dose methylprednisolone was significantly associated with decreased laboratory markers, time of recovery, and the need for transfer to critical care unit.

An ambispective cohort study aimed to distinguish between the clinical outcome and laboratory results of dexamethasone (DXM) 6 mg and methylprednisolone (MTP) high-dose in severely ill hospitalized SARS-CoV-2 patients diagnosed with pneumonia.

This study encompasses the survival analysis of 216 hospitalized patients suffering from severe Covid-19 pneumonia. The patients also had additional oxygen and radiological verification of pneumonia with the help of chest tomography.

As per hospital protocol, a total of 111 patients were treated with DXM 6 mg intravenously (IV) once daily for 7-10 days if they needed oxygen. As per the modified hospital protocol, a high dose (250-500 mg) of MTP was used every day for 3 days, followed by prednisone 50 mg daily for 14 days.  

The protocol was not applied in critical care unit (CCU), where administration of dexamethasone was continued. The clinical outcome and differences in lab findings of dexamethasone-recipients versus the prospective cohort that were given methylprednisolone were assessed. Follow-up was conducted by outpatient consultation after a month of hospital discharge or by phone, questioning about readmission or living-dead status.

Out of 216 patients with Covid-19 pneumonia, 111 received DXM and 105 received MTP. More people (26.1%) in the DXM arm evolved to severe Acute Respiratory Distress Syndrome (ARDS) in comparison with the MTP arm (17.1%). Patients in the MTP group had considerably decreased laboratory markers of severity upon 4 days of treatment. Also, the transfer to the CCU and mortality was lower along with a shorter time of recovery in this group. More patients were alive in the MTP group than the DXM group at 30-day follow-up (Table 1):

The use of methylprednisolone 250-500 mg every day for 3 days followed by prednisone 50 mg taken orally daily for 2 weeks is a more effective treatment option in COVID-19 people with pneumonia as compared to dexamethasone 6 mg administered intravenously once daily for 7-10 days. In this study, the treatment of severe Covid-19 Pneumonia with high-dose methylprednisolone for three days followed by oral prednisone for 14 days, compared with 6 mg dexamethasone for 7 to 10 days, statistically significantly decreased the recovery time, the need for transfer to intensive care and the severity markers C-reactive protein (CRP), D-dimer and LDH. Randomized controlled studies with methylprednisolone are required to corroborate its effect, and studies in a population hospitalized in intensive care wards.In this study, the treatment of severe Covid-19 Pneumonia with high-dose methylprednisolone for three days followed by oral prednisone for 14 days, compared with 6 mg dexamethasone for 7 to 10 days, statistically significantly decreased the recovery time, the need for transfer to intensive care and the severity markers C-reactive protein (CRP), D-dimer and LDH. Randomized controlled studies with methylprednisolone are required to corroborate its effect, and studies in a population hospitalized in intensive care wards.