Open Forum Infect Dis . Low- Versus High-Dose Methylprednisolone in Adult Patients With Coronavirus Disease 2019: Less Is More

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Open Forum Infect Dis


. 2021 Dec 8;9(1):ofab619.
doi: 10.1093/ofid/ofab619. eCollection 2022 Jan.
Low- Versus High-Dose Methylprednisolone in Adult Patients With Coronavirus Disease 2019: Less Is More


Seema Joshi ¹ , Zachary Smith ² , Sana Soman ¹ , Saniya Jain ¹ , Atheel Yako ¹ , Marwa Hojeij ¹ , Louis Massoud ¹ , Ayman Alsaadi ³ , Jonathan Williams ¹ , Rachel Kenney ² , Joseph Miller ⁴ , George Alangaden ¹ , Mayur Ramesh ¹



Affiliations

• PMID: 35024376
• PMCID: PMC8689728
• DOI: 10.1093/ofid/ofab619

Abstract

Background: Corticosteroids use in severe coronavirus disease 2019 (COVID-19) improves survival; however, the optimal dose is not established. We aim to evaluate clinical outcomes in patients with severe COVID-19 receiving high-dose corticosteroids (HDC) versus low-dose corticosteroids (LDC).
Methods: This was a quasi-experimental study conducted at a large, quaternary care center in Michigan. A corticosteroid dose change was implemented in the standardized institutional treatment protocol on November 17, 2020. All patients admitted with severe COVID-19 that received corticosteroids were included. Consecutive patients in the HDC group (September 1 to November 15, 2020) were compared to the LDC group (November 30, 2020 to January 20, 2021). High-dose corticosteroids was defined as 80 mg of methylprednisolone daily in 2 divided doses, and LDC was defined as 32-40 mg of methylprednisolone daily in 2 divided doses. The primary outcome was all-cause 28-day mortality. Secondary outcomes included progression to mechanical ventilation, hospital length of stay (LOS), discharge on supplemental oxygen, and corticosteroid-associated adverse events.
Results: Four-hundred seventy patients were included: 218 (46%) and 252 (54%) in the HDC and LDC groups, respectively. No difference was observed in 28-day mortality (14.5% vs 13.5%, P = .712). This finding remained intact when controlling for additional variables (odds ratio, 0.947; confidence interval, 0.515-1.742; P = .861). Median hospital LOS was 6 and 5 days in the HDC and LDC groups, respectively (P < .001). No differences were noted in any of the other secondary outcomes.
Conclusions: Low-dose methylprednisolone had comparable outcomes including mortality to high-dose methylprednisolone for the treatment of severe COVID-19.

Keywords: 19; 2; 28; COVID; CoV; SARS; day mortality; hypoxia; methylprednisolone.