Comparison of the effect of intravenous dexamethasone and methylprednisolone on the treatment of hospitalized patients with COVID-19: A randomized clinical trial

Abstract

OBJECTIVE: To compare the effects of intravenous dexamethasone and methylprednisolone on the treatment of inpatients with COVID-19. METHODS: In this randomized clinical trial, 143 patients under 80 years of age with moderate to severe COVID-19 were enrolled and randomly assigned to two groups: dexamethasone (8 mg/day) and methylprednisolone (60 mg/day in two divided doses). The primary outcome was the length of hospital stay and the secondary outcomes included: duration of oxygen therapy, absolute leukocyte and lymphocyte count, hypokalemia, hyperglycemia, ICU admission, and mortality in the two groups for 28 days. Data were analyzed by SPSS 26 using t-test, chi-square and ANOVA. RESULTS: The duration of hospitalization was significantly (p<0.001) shorter in the dexamethasone group in compared with methylprednisolone group 8 (95% CI:6-10) and 11 (95% CI:7-14), respectively. In addition, duration of oxygen therapy in the dexamethasone group 7 (95% CI:5-9) was significantly (p<0.001) shorter in compared with methylprednisolone group 10 (95% CI:5.5-14). The mortality rate was 17.1% (95% CI: 8.1-26.1) in dexamethasone group and 12.3% (95% CI: 4.6-20.0) in methylprednisolone group which was not statistically significantly (P=0.46). CONCLUSION: Results showed better effectiveness of 8 mg/day dexamethasone compared to 60 mg/day methylprednisolone based on the shorter hospital stay, which can be taken into consideration in the therapeutic protocol of COVID-19. TRIAL REGISTRATION: IRCT20210223050466N1.