According to research published online on Oct 28, the number of days lived without life support at day 28 did not differ between persons with COVID-19 and severe hypoxemia receiving dexamethasone 12 mg/day versus dexamethasone 6 mg/day administered intravenously for up to 10 days.
In patients with COVID-19 and severe hypoxemia, Marie W. Munch, M.D., and colleagues from the COVID STEROID 2 Trial Group examined the effects of 12 mg/day against 6 mg/day of dexamethasone.
In Severe Cases, A Higher Steroid Dose Has Little Effect On Covid
Though many experts have tried different medicines including steroids to improve the medical condition of the patients, most of them have failed or led to terrible side effects on other organs of the body. Even steroids are proven inefficient against the effect of Coronavirus as per research.
Patients with confirmed COVID-19 requiring at least 10 L/min of oxygen or mechanical ventilation were treated at 26 hospitals in Europe and India from August 2020 to May 2021, with 491 receiving 12 mg dexamethasone and 480 receiving 6 mg.
The researchers discovered that in the group getting 12 mg of dexamethasone, the median number of days alive without life support was 22.0 days, compared to 20.5 days in the group receiving 6 mg of dexamethasone (adjusted mean difference, 1.3 days). Mortality rates at 28 days were 27.1 and 32.3 percent, respectively (adjusted relative risk, 0.86; 99 percent confidence interval [CI], 0.68 to 1.08).
Mortality rates at 90 days were 32.0 and 37.7%, respectively (adjusted relative risk, 0.87; 99 percent CI, 0.70 to 1.07).
Serious adverse responses, such as septic shock and invasive fungal infections, occurred in 11.3 percent in the high-dose group versus 13.4% in the low-dose group (adjusted relative risk, 0.83; 99 percent CI, 0.54 to 1.29).
The findings are suggestive of better outcomes with 12 mg/d dexamethasones, but not conclusive, and do not meet the typical criteria for recommending a change in treatment.
COVID-19 is characterized by a dysregulated hyperimmune response, and steroid treatment has been demonstrated to reduce mortality. However, whether or not higher steroid doses lead to better results has been a point of contention.
COVID-19 admissions between March 1, 2020, and March 10, 2021, were studied retrospectively. Adult patients (18 years) who received more than 10 mg of methylprednisolone equivalent dose (MED) daily for the first 14 days were included in the study.
Patients who were released or died within 7 days of admission were not included in the study.
In-hospital mortality, acute kidney damage (AKI) necessitating hemodialysis, Invasive Mechanical Ventilation (IMV), hospital-associated infections (HAI), and readmissions were among the outcomes evaluated.
506 patients received less than 40 mg of MED (median dose 30 mg MED) and 873 received more than or equal to 40 mg of MED (median dose 78 mg MED) of the 1379 patients who met study criteria.
Patients who took high-dose corticosteroids had a higher unadjusted in-hospital death rate (40.7% vs. 18.6%, p 0.001).
Ground-glass imaging revealed 216 patients with Covid-19 pneumonia and an alveolar pressure / inspired oxygen fraction (PaFi) of less than 300. Dexamethasone (DXM) was given to 111 patients, whereas methylprednisolone was given to 105 (MTP).
A larger number of patients in the DXM group developed severe ARDS (26.1 percent vs 17.1 percent than the MTP group).
Treatment of severe Covid-19 Pneumonia with high-dose methylprednisolone for three days followed by oral prednisone for 14 days, compared to 6 mg dexamethasone for 7 to 10 days, reduced recovery time, the need for critical care, and the severity indicators C-reactive protein (CRP), D- dimer, and LDH.
To confirm its effect, randomized controlled studies with methylprednisolone are needed, as well as research in a population of patients in intensive care units.
