A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial
Abstract Background The most appropriate anti-inflammatory treatment for moderate COVID-19 pneumonia remains uncertain. We aimed to compare the effectiveness of a high-dose methylprednisolone versus a high-dose dexamethasone in hospitalized moderate COVID-19 pneumonia, regarding the WHO clinical pro...
Saved in:
| Main Authors: | , , , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
BMC
2024-11-01
|
| Series: | BMC Pulmonary Medicine |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12890-024-03364-4 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1846165613298319360 |
|---|---|
| author | Jakkrit Laikitmongkhon Tanapat Tassaneyasin Yuda Sutherasan Angsana Phuphuakrat Sirawat Srichatrapimuk Tananchai Petnak Dararat Eksombatchai Kanin Thammavaranucupt Somnuek Sungkanuparph |
| author_facet | Jakkrit Laikitmongkhon Tanapat Tassaneyasin Yuda Sutherasan Angsana Phuphuakrat Sirawat Srichatrapimuk Tananchai Petnak Dararat Eksombatchai Kanin Thammavaranucupt Somnuek Sungkanuparph |
| author_sort | Jakkrit Laikitmongkhon |
| collection | DOAJ |
| description | Abstract Background The most appropriate anti-inflammatory treatment for moderate COVID-19 pneumonia remains uncertain. We aimed to compare the effectiveness of a high-dose methylprednisolone versus a high-dose dexamethasone in hospitalized moderate COVID-19 pneumonia, regarding the WHO clinical progression scales, mortality, and the length of hospitalization. Methods In this open-labeled randomized controlled trial, we enrolled patients with age > 18 years old who were diagnosed moderate COVID-19 pneumonia confirmed by real-time PCR, evidence of pneumonia by chest imaging and resting oxygen saturation between 90 and 94%. Patients were randomized at a 1:1 ratio to receive methylprednisolone 250 mg/day or dexamethasone 20 mg/day over the first three days. Then the patients in both groups received dexamethasone 20 mg/day on days 4–5, and 10 mg/day on days 6–10. Primary outcome was assessed by a 10-point WHO clinical progression scales ranging from uninfected (point 0) to death (point 10) on the fifth day of treatment. Secondary outcomes including 90-day mortality, length of hospitalization, rate of intensive care unit (ICU) transfer and complications were determined. Results Of 98 eligible patients, the mean age was 76.0 ± 13.3 years. The median date of illness at the time of randomization was 3 days (interquartile range 2, 5). Baseline clinical characteristics and severity did not differ between groups. The WHO clinical progression scales were similar between methylprednisolone and dexamethasone group at 5 and 10 days of treatment [4.84, (95% confidence interval(CI), 4.35–5.33) vs. 4.76 (95% CI, 4.27–5.25), p = 0.821 and 4.32 (95% CI, 3.83–4.81) vs. 3.80 (95% CI, 3.31–4.29), p = 0.140, respectively)]. Both groups did not differ in-hospital mortality, length of hospitalization, and rate of ICU transfer. There were also no differences in steroid-related complications between groups until 90 days of follow-up. Conclusions In patients with moderate COVID-19 pneumonia, initial anti-inflammatory treatment with 250 mg/day of methylprednisolone for three days does not yield better outcomes over high-dose dexamethasone. Trial registration This study was registered at Thai Clinical Trials Registry on October 17, 2021, with the identifier TCTR20211017001. |
| format | Article |
| id | doaj-art-3d77ded90e494dc48bc0cbcbd2b6f9cb |
| institution | Kabale University |
| issn | 1471-2466 |
| language | English |
| publishDate | 2024-11-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj-art-3d77ded90e494dc48bc0cbcbd2b6f9cb2024-11-17T12:08:00ZengBMCBMC Pulmonary Medicine1471-24662024-11-0124111010.1186/s12890-024-03364-4A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trialJakkrit Laikitmongkhon0Tanapat Tassaneyasin1Yuda Sutherasan2Angsana Phuphuakrat3Sirawat Srichatrapimuk4Tananchai Petnak5Dararat Eksombatchai6Kanin Thammavaranucupt7Somnuek Sungkanuparph8Division of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol UniversityDivision of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDivision of Infectious Diseases, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol UniversityDivision of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityDivision of Pulmonary and Pulmonary Critical Care Medicine, Department of Medicine, Faculty of Medicine Ramathibodi Hospital, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol UniversityFaculty of Medicine Ramathibodi Hospital, Chakri Naruebodindra Medical Institute, Mahidol UniversityAbstract Background The most appropriate anti-inflammatory treatment for moderate COVID-19 pneumonia remains uncertain. We aimed to compare the effectiveness of a high-dose methylprednisolone versus a high-dose dexamethasone in hospitalized moderate COVID-19 pneumonia, regarding the WHO clinical progression scales, mortality, and the length of hospitalization. Methods In this open-labeled randomized controlled trial, we enrolled patients with age > 18 years old who were diagnosed moderate COVID-19 pneumonia confirmed by real-time PCR, evidence of pneumonia by chest imaging and resting oxygen saturation between 90 and 94%. Patients were randomized at a 1:1 ratio to receive methylprednisolone 250 mg/day or dexamethasone 20 mg/day over the first three days. Then the patients in both groups received dexamethasone 20 mg/day on days 4–5, and 10 mg/day on days 6–10. Primary outcome was assessed by a 10-point WHO clinical progression scales ranging from uninfected (point 0) to death (point 10) on the fifth day of treatment. Secondary outcomes including 90-day mortality, length of hospitalization, rate of intensive care unit (ICU) transfer and complications were determined. Results Of 98 eligible patients, the mean age was 76.0 ± 13.3 years. The median date of illness at the time of randomization was 3 days (interquartile range 2, 5). Baseline clinical characteristics and severity did not differ between groups. The WHO clinical progression scales were similar between methylprednisolone and dexamethasone group at 5 and 10 days of treatment [4.84, (95% confidence interval(CI), 4.35–5.33) vs. 4.76 (95% CI, 4.27–5.25), p = 0.821 and 4.32 (95% CI, 3.83–4.81) vs. 3.80 (95% CI, 3.31–4.29), p = 0.140, respectively)]. Both groups did not differ in-hospital mortality, length of hospitalization, and rate of ICU transfer. There were also no differences in steroid-related complications between groups until 90 days of follow-up. Conclusions In patients with moderate COVID-19 pneumonia, initial anti-inflammatory treatment with 250 mg/day of methylprednisolone for three days does not yield better outcomes over high-dose dexamethasone. Trial registration This study was registered at Thai Clinical Trials Registry on October 17, 2021, with the identifier TCTR20211017001.https://doi.org/10.1186/s12890-024-03364-4COVID-19Moderate pneumoniaCorticosteroidsRandomized controlled trial |
| spellingShingle | Jakkrit Laikitmongkhon Tanapat Tassaneyasin Yuda Sutherasan Angsana Phuphuakrat Sirawat Srichatrapimuk Tananchai Petnak Dararat Eksombatchai Kanin Thammavaranucupt Somnuek Sungkanuparph A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial BMC Pulmonary Medicine COVID-19 Moderate pneumonia Corticosteroids Randomized controlled trial |
| title | A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial |
| title_full | A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial |
| title_fullStr | A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial |
| title_full_unstemmed | A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial |
| title_short | A comparative study between methylprednisolone versus dexamethasone as an initial anti-inflammatory treatment of moderate COVID-19 pneumonia: an open-label randomized controlled trial |
| title_sort | comparative study between methylprednisolone versus dexamethasone as an initial anti inflammatory treatment of moderate covid 19 pneumonia an open label randomized controlled trial |
| topic | COVID-19 Moderate pneumonia Corticosteroids Randomized controlled trial |
| url | https://doi.org/10.1186/s12890-024-03364-4 |
| work_keys_str_mv | AT jakkritlaikitmongkhon acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT tanapattassaneyasin acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT yudasutherasan acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT angsanaphuphuakrat acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT sirawatsrichatrapimuk acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT tananchaipetnak acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT dararateksombatchai acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT kaninthammavaranucupt acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT somnueksungkanuparph acomparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT jakkritlaikitmongkhon comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT tanapattassaneyasin comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT yudasutherasan comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT angsanaphuphuakrat comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT sirawatsrichatrapimuk comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT tananchaipetnak comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT dararateksombatchai comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT kaninthammavaranucupt comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial AT somnueksungkanuparph comparativestudybetweenmethylprednisoloneversusdexamethasoneasaninitialantiinflammatorytreatmentofmoderatecovid19pneumoniaanopenlabelrandomizedcontrolledtrial |