Low versus High Dose Methylprednisolone in Adult Patients with COVID-19: Less is More

ABSTRACT

Background Corticosteroids use in severe 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 17 November 2020. All patients admitted with severe COVID-19 that received corticosteroids were included. Consecutive patients in the HDC group (1 September to 15 November 2020) were compared to the LDC group (30 November 2020 to 20 January 2021). HDC was defined as methylprednisolone 80 mg daily in two divided doses and LDC was defined as methylprednisolone 32-40 mg daily in two 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 and 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=0.712). This finding remained intact when controlling for additional variables (OR 0.947, [CI 0.515-1.742], p=0.861). Median hospital LOS was 6 and 5 days in the HDC and LDC groups, respectively (p<0.001). 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.