In patients with COVID-19, treatment with methylprednisolone may reduce short-term mortality and the need for intensive care unit (ICU) admission and mechanical ventilation, according to a meta-analysis published in Steroids.
Inhibiting hyper-inflammatory response and preventing tissue damage is a focus of COVID-19 treatment in addition to active antiviral therapy. However, it is uncertain which glucocorticoid agent is ideal.
Methylprednisolone is the preferred agent for the treatment of acute respiratory distress syndrome (ARDS) in the ICU. Because there have been several studies on methylprednisolone treatment in patients with COVID-19, researchers conducted a meta-analysis to evaluate its efficacy and safety in the treatment of COVID-19 patients. After searching PubMed, Cochrane, and Web of Science, they identified 33 eligible studies, including 5 randomized trials and 28 observational studies.
The researchers found that compared with no glucocorticoids, methylprednisolone was associated with reduced short-term mortality, less need for ICU admission and mechanical ventilation, and increased 28-day ventilator-free days in COVID-19 patients. Although methylprednisolone does not appear to increase the risk of secondary infections, it may prolong the duration of viral shedding in these patients. Researchers performed subgroup analyses in severe COVID-19 patients and demonstrated that low-dose (≤2mg/kg/day) methylprednisolone treatment for 7 or fewer days was associated with relatively better clinical outcomes and did not increase the duration of viral shedding.
“Compared with no glucocorticoids, methylprednisolone treatment in COVID-19 patients is associated with reduced short-term mortality and better clinical outcomes, without increasing secondary infections, but could slightly prolong duration of viral shedding,” the researchers concluded. They added, “Patients with severe COVID-19 are more likely to benefit from short-term low-dose methylprednisolone treatment (1 to 2 mg/kg/day for ≤7 days).” However, randomized controlled trials are needed to confirm these findings.
Hong S, Wang H, Zhang Z, Qiao L. The roles of methylprednisolone treatment in patients with COVID-19: A systematic review and meta-analysis. Steroids. Published online on March 26, 2022. doi:10.1016/j.steroids.2022.109022