Low- Versus High-Dose Methylprednisolone in Adult Patients With Coronavirus Disease 2019: Less Is More

Authors

Seema Joshi, Henry Ford HealthFollow
Zachary R. Smith, Henry Ford HealthFollow
Sana Soman, Henry Ford HealthFollow
Saniya Jain, Henry Ford HealthFollow
Atheel Yako, Henry Ford HealthFollow
Marwa Hojeij, Henry Ford HealthFollow
Louis Massoud, Henry Ford HealthFollow
Ayman Alsaadi, Henry Ford HealthFollow
Jonathan Williams, Henry Ford HealthFollow
Rachel M. Kenney, Henry Ford HealthFollow
Joseph B. Miller MD, Henry Ford HealthFollow
George Alangaden, Henry Ford HealthFollow
Mayur Ramesh, Henry Ford HealthFollow

Recommended Citation

Joshi S, Smith Z, Soman S, Jain S, Yako A, Hojeij M, Massoud L, Alsaadi A, Williams J, Kenney R, Miller J, Alangaden G, and Ramesh M. Low- Versus High-Dose Methylprednisolone in Adult Patients With Coronavirus Disease 2019: Less Is More. Open Forum Infect Dis 2022; 9(1):ofab619.

Document Type

Article

Publication Date

1-1-2022

Publication Title

Open Forum Infect Dis

Abstract

Background: Corticosteroids use in severe coronavirus disease 2019 (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 November 17, 2020. All patients admitted with severe COVID-19 that received corticosteroids were included. Consecutive patients in the HDC group (September 1 to November 15, 2020) were compared to the LDC group (November 30, 2020 to January 20, 2021). High-dose corticosteroids was defined as 80 mg of methylprednisolone daily in 2 divided doses, and LDC was defined as 32-40 mg of methylprednisolone daily in 2 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 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 = .712). This finding remained intact when controlling for additional variables (odds ratio, 0.947; confidence interval, 0.515-1.742; P = .861). Median hospital LOS was 6 and 5 days in the HDC and LDC groups, respectively (P < .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.

PubMed ID

35024376

Volume

9

Issue

1

First Page

619

Last Page

619