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Comparison of the efficacy of equivalent doses of dexamethasone, methylprednisolone, and hydrocortisone for treatment of COVID-19-related acute respiratory distress syndrome: a prospective three-arm randomized clinical trial.
Taher, Abbas; Lashkari, Marjan; Keramat, Fariba; Hashemi, Seyyed Hamid; Sedighi, Ladan; Poorolajal, Jalal; Mehrpooya, Maryam.
  • Taher A; Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
  • Lashkari M; Department of Anesthesiology and Critical Care, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
  • Keramat F; Department Infectious Disease, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
  • Hashemi SH; Department Infectious Disease, School of Medicine, Hamadan University of Medical Sciences, Hamadan, Iran.
  • Sedighi L; Department of medical and surgical nursing, school of nursing and midwifery, Shahid Beheshti university of Medical Sciences, Tehran, Iran.
  • Poorolajal J; Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
  • Mehrpooya M; Department of Clinical Pharmacy, School of Pharmacy, Medicinal Plants and Natural Products Research Center, Hamadan University of Medical Sciences, Shahid Fahmideh Ave, 6517838678, Hamadan, Iran. m_mehrpooya2003@yahoo.com.
Wien Med Wochenschr ; 173(5-6): 140-151, 2023 Apr.
Article in English | MEDLINE | ID: covidwho-2174438
ABSTRACT

BACKGROUND:

This prospective controlled clinical trial aimed to compare the efficacy of methylprednisolone, dexamethasone, and hydrocortisone at equivalent doses in patients with severe COVID-19.

METHODS:

In total, 106 patients with mild to moderate COVID-19-related acute respiratory distress syndrome (ARDS) were randomized to receive either dexamethasone (6 mg once a day), methylprednisolone (16 mg twice a day), or hydrocortisone (50 mg thrice a day) for up to 10 days. All participants received a standard of care for COVID-19. The primary and secondary efficacy outcomes included all-cause 28-day mortality, clinical status on day 28 assessed using the World Health Organization (WHO) eight-category ordinal clinical scale, number of patients requiring mechanical ventilation and intensive care unit (ICU) care, number of ventilator-free days, length of hospital and ICU stay, change in PaO2FiO2 ratios during the first 5 days after treatment, and incidence of serious adverse events. P-values below 0.008 based on Bonferroni's multiple-testing correction method were considered statistically significant.

RESULTS:

According to the obtained results, there was a trend toward more favorable clinical outcomes in terms of needing mechanical ventilation and ICU care, number of ventilator-free days, change in PaO2FiO2 ratios during the first 5 days after treatment, clinical status score at day 28, length of ICU and hospital stay, and overall 28-day mortality in patients receiving dexamethasone compared to those receiving methylprednisolone or hydrocortisone; however, likely due to the study's small sample size, the difference between groups reached a significant level only in the case of clinical status score on day 28 (p-value = 0.003). There was no significant difference in the incidence of serious adverse events between the study groups.

CONCLUSION:

Based on the results, severe cases of COVID-19 treated with dexamethasone might have a better clinical status at 28-day follow-up compared to methylprednisolone and hydrocortisone at an equivalent dose. Larger multicenter trials are required to confirm our findings.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Wien Med Wochenschr Journal subject: Medicine Year: 2023 Document Type: Article Affiliation country: S10354-022-00993-4

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Respiratory Distress Syndrome / COVID-19 Type of study: Cohort study / Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Topics: Long Covid Limits: Humans Language: English Journal: Wien Med Wochenschr Journal subject: Medicine Year: 2023 Document Type: Article Affiliation country: S10354-022-00993-4