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Abstract
Coronavirus disease 2019 (COVID-19) is associated with fatal acute respiratory distress syndrome, which can be ameliorated by methylprednisolone pulse therapy, thereby reducing the risk of progression to respiratory failure and death. We aimed to determine the efficacy and safety of methylprednisolone pulse therapy for patients with COVID-19 pneumonia. In this retrospective, observational cohort study, seventy patients (age, 35–91 years) who were admitted to Saitama Medical University Hospital in Japan between March 2020 and January 2021 due to COVID-19 pneumonia were included. The difference in mortality between the methylprednisolone pulse therapy (n = 22) and dexamethasone therapy (n = 48) groups was the primary outcome. Between-group differences in the average length of intensive care unit stay, duration of invasive mechanical ventilation, and incidence of treatment-related adverse events were the secondary outcomes. The methylprednisolone pulse therapy group showed a significantly lower mortality rate (3.8% vs. 20.2%, p = 0.006) and increased survival rate compared with the dexamethasone therapy group (p = 0.044). Additionally, without statistical significance, the average length of intensive care unit stay tended to be shorter in the methylprednisolone pulse therapy group (11.5 ± 6.1 days) than in the dexamethasone therapy group (22.3 ± 23.1 days) (p = 0.793). The average duration of invasive mechanical ventilation also tended to be shorter in the methylprednisolone pulse therapy group (15.3 ± 10.1 vs. 28.8 ± 9.2 days, p = 0.120). There were no significant differences in the incidence of treatment-related serious adverse events between the two groups. In conclusion, methylprednisolone pulse therapy for patients with COVID-19 pneumonia significantly reduced mortality and increased the survival rate compared to conventional dexamethasone therapy.
Highlights
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is responsible for the coronavirus disease 2019 (COVID-19) pandemic, which originated in late 2019 in the Chinese city of Wuhan [1]
We investigated the mortality rate and incidence of adverse events of methylprednisolone pulse therapy compared with conventional dexamethasone therapy in patients with COVID-19 pneumonia using propensity score-based inverse probability weighting (IPW)
Twenty-two of them were assigned to methylprednisolone pulse therapy and the remaining 48 were assigned to dexamethasone therapy
Summary
Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is responsible for the coronavirus disease 2019 (COVID-19) pandemic, which originated in late 2019 in the Chinese city of Wuhan [1]. Cytokine storm has been reported to be associated with one of the causes of exacerbations and death from COVID-19 [3]. A cytokine storm comprises macrophages, neutrophils, and lymphocytes that infiltrate alveolar epithelial cells, which release large amounts of inflammatory cytokines, chemokines, and leukocytosis factors, such as interleukin (IL)-6, tumor necrosis factor-α, IL-1β, interferon, IL-18, interferon gamma-induced protein 10, monocyte chemoattractant protein-1, monocyte colony-stimulating factor, and granulocyte colony-stimulating factor [3]. These inflammatory mediators induce a systemic inflammatory response, thereby causing fatal acute respiratory distress syndrome (ARDS) [3]
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