METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT)
Intro: Dexamethasone, a corticosteroid, was recently demonstrated to be the only medication capable of reducing mortality in severe COVID disease in the UK's Recovery Trial. There is a need to compare different steroids because it is well recognised that different corticosteroids have varied ph...
| Main Authors: | , , , , , , |
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| Format: | Article |
| Language: | English |
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Elsevier
2023-05-01
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| Series: | International Journal of Infectious Diseases |
| Online Access: | http://www.sciencedirect.com/science/article/pii/S1201971223005039 |
| _version_ | 1797824545923530752 |
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| author | N. Nasir S. Fatima S. Awan M. Zakariya A. Arshad F. Khalid M. Aqeel N. Nasir |
| author_facet | N. Nasir S. Fatima S. Awan M. Zakariya A. Arshad F. Khalid M. Aqeel N. Nasir |
| author_sort | N. Nasir |
| collection | DOAJ |
| description | Intro: Dexamethasone, a corticosteroid, was recently demonstrated to be the only medication capable of reducing mortality in severe COVID disease in the UK's Recovery Trial. There is a need to compare different steroids because it is well recognised that different corticosteroids have varied pharmacodynamic properties. The aim of our study was to compare outcomes in severe or critical COVID-19 when treated with Dexamethasone versus Methyl prednisolone. Methods: We conducted a retrospective quasi-experimental, non-randomized study to determine whether intravenous or oral dexamethasone reduces mortality compared with intravenous methylprednisolone in patients with severe or critical COVID-19.The study was conducted on all patients aged 18 and over admitted at a 700‐bedded academic medical center.The primary outcome was the mortality. The secondary outcome included length of stay. Findings: A total of 706 hospitalized patients with moderate to severe COVID- 19 were included in the study. There were n=217 patients in Dexamethasone group, n= 393 patients in Methylprednisolone group and n=96 patients who did not receive steroids.Among the baseline characteristics between the groups, there was no significant difference in median age (55 years in dexamethsone group vs 57 years in methyl prednisolone group p=0.09). There was male predominance in methylprednisolone group (74% versus 54% p<0.001) and a greater proportion of patients who required invasive mechanical ventilation (13.7% versus 3.2% p<0.001). Mortality was found to be significantly higher in methylprednisolone group compared to dexamethasone group on univariate logistic regression analysis (13.7% versus 3.2% p<0.001) and longer length of stay (7 days versus 4 days p<0.001). In multivariable model, dexamethsone was found to be associated with lower risk of mortality (aOR: 0.24; 95% CI: (0.09- 0.62)(p=0.003) and lesser length of stay (aOR: 0.87; 95% CI: (0.82-0.92) (p<0.001). Conclusion: Dexamethasone was associated with lower mortality and lesser length of stay when compared to Methyl prednisolone in moderate to critical COVID-19. |
| first_indexed | 2024-03-13T10:40:35Z |
| format | Article |
| id | doaj.art-f9b366f553f740c483f7cee19aa133e2 |
| institution | Directory Open Access Journal |
| issn | 1201-9712 |
| language | English |
| last_indexed | 2024-03-13T10:40:35Z |
| publishDate | 2023-05-01 |
| publisher | Elsevier |
| record_format | Article |
| series | International Journal of Infectious Diseases |
| spelling | doaj.art-f9b366f553f740c483f7cee19aa133e22023-05-18T04:39:12ZengElsevierInternational Journal of Infectious Diseases1201-97122023-05-01130S151S152METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT)N. Nasir0S. Fatima1S. Awan2M. Zakariya3A. Arshad4F. Khalid5M. Aqeel6N. Nasir7Aga Khan University, Medicine, Karachi, PakistanAga Khan University, Medicine, Karachi, PakistanAga Khan University, Medicine, Karachi, PakistanAga Khan University, Medicine, Karachi, PakistanAga Khan University, Medicine, Karachi, PakistanAga Khan University, Medicine, Karachi, PakistanAga Khan University, Medicine, Karachi, PakistanAga Khan University, Medicine, Karachi, PakistanIntro: Dexamethasone, a corticosteroid, was recently demonstrated to be the only medication capable of reducing mortality in severe COVID disease in the UK's Recovery Trial. There is a need to compare different steroids because it is well recognised that different corticosteroids have varied pharmacodynamic properties. The aim of our study was to compare outcomes in severe or critical COVID-19 when treated with Dexamethasone versus Methyl prednisolone. Methods: We conducted a retrospective quasi-experimental, non-randomized study to determine whether intravenous or oral dexamethasone reduces mortality compared with intravenous methylprednisolone in patients with severe or critical COVID-19.The study was conducted on all patients aged 18 and over admitted at a 700‐bedded academic medical center.The primary outcome was the mortality. The secondary outcome included length of stay. Findings: A total of 706 hospitalized patients with moderate to severe COVID- 19 were included in the study. There were n=217 patients in Dexamethasone group, n= 393 patients in Methylprednisolone group and n=96 patients who did not receive steroids.Among the baseline characteristics between the groups, there was no significant difference in median age (55 years in dexamethsone group vs 57 years in methyl prednisolone group p=0.09). There was male predominance in methylprednisolone group (74% versus 54% p<0.001) and a greater proportion of patients who required invasive mechanical ventilation (13.7% versus 3.2% p<0.001). Mortality was found to be significantly higher in methylprednisolone group compared to dexamethasone group on univariate logistic regression analysis (13.7% versus 3.2% p<0.001) and longer length of stay (7 days versus 4 days p<0.001). In multivariable model, dexamethsone was found to be associated with lower risk of mortality (aOR: 0.24; 95% CI: (0.09- 0.62)(p=0.003) and lesser length of stay (aOR: 0.87; 95% CI: (0.82-0.92) (p<0.001). Conclusion: Dexamethasone was associated with lower mortality and lesser length of stay when compared to Methyl prednisolone in moderate to critical COVID-19.http://www.sciencedirect.com/science/article/pii/S1201971223005039 |
| spellingShingle | N. Nasir S. Fatima S. Awan M. Zakariya A. Arshad F. Khalid M. Aqeel N. Nasir METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT) International Journal of Infectious Diseases |
| title | METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT) |
| title_full | METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT) |
| title_fullStr | METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT) |
| title_full_unstemmed | METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT) |
| title_short | METHYLPREDNISOLONE VERSUS DEXAMETHASONE FOR TREATMENT OF SEVERE OR CRITICAL COVID-19: A QUASI-EXPERIMENTAL STUDY (MD TREAT) |
| title_sort | methylprednisolone versus dexamethasone for treatment of severe or critical covid 19 a quasi experimental study md treat |
| url | http://www.sciencedirect.com/science/article/pii/S1201971223005039 |
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