Prolonged higher dose methylprednisolone vs. conventional dexamethasone in COVID-19 pneumonia: a randomised controlled trial (MEDEAS).
Eur Respir J
; 2022 Nov 10.
Article
in English
| MEDLINE | ID: covidwho-2303005
ABSTRACT
INTRODUCTION:
Dysregulated systemic inflammation is the primary driver of mortality in severe COVID-19 pneumonia. Current guidelines favor a 7-10-day course of any glucocorticoid equivalent to dexamethasone 6â mg·day-1. A comparative RCT with a higher dose and a longer duration of intervention was lacking.METHODS:
We conducted a multi-center, open-label RCT to investigate methylprednisolone 80 mg as a continuous daily infusion for 8â days followed by slow tapering versus dexamethasone 6â mg daily for up to 10 days in adult patients with COVID-19 pneumonia requiring oxygen or noninvasive respiratory support. PRIMARYOUTCOME:
reduction in 28-day mortality. SECONDARYOUTCOMES:
mechanical ventilation-free days at 28â days, need for ICU referral, length of hospitalisation, need for tracheostomy, changes in PaO2FiO2 ratio, C-reactive protein levels and WHO clinical progression scale at days 3, 7, and 14.RESULTS:
677 randomised patients were included. Findings are reported as methylprednisolone (n=337) versus dexamethasone (n=340). By day 28, there were no significant differences in mortality (35[10.4%] versus 41[12.1%]; p=0.49), nor in the median mechanical ventilation-free days (23[14] versus 24[16]; p=0.49). ICU referral was necessary in 41[12.2%] versus 45[13.2%]; p=0.68 and tracheostomy in 8[2.4%] versus 9[2.6%]; p=0.82. Survivors in the methylprednisolone group required a longer median hospitalisation (15[11] versus 14[11] days; p=0.005) and experienced an improvement in C-reactive protein levels, but not in PaO2FiO2 ratio, at days 7 and 14. There were no differences in disease progression at the prespecified timepoints.CONCLUSION:
Prolonged, higher dose methylprednisolone did not reduce mortality at 28 days compared to conventional dexamethasone in COVID-19 pneumonia.
Full text:
Available
Collection:
International databases
Database:
MEDLINE
Type of study:
Experimental Studies
/
Prognostic study
/
Randomized controlled trials
Language:
English
Year:
2022
Document Type:
Article
Affiliation country:
13993003.01514-2022
Similar
MEDLINE
...
LILACS
LIS