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High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia

Introduction: The use of dexamethasone (DXM) has been associated with decreased mortality in the patients with hypoxemia during the coronavirus disease-2019 (COVID-19) pandemic, while the outcomes with methylprednisolone (MTP) have been mixed. This real-life study aimed to evaluate the outcomes of p...

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Main Authors:	Soo, Chun Ian, Poon, Khai Vern, Ayub, Atiqah, You, Hui Wen, Tan, Chai Xian, Loh, Kenneth Jia Juin, Eng, Carolyn Chai Hui, Sia, Leng Cheng, Wong, Chee Kuan
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Published:	Malaysian Medical Association 2024
Subjects:	R Medicine
Online Access:	http://eprints.um.edu.my/44953/
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spelling	my.um.eprints.449532024-04-29T04:28:09Z http://eprints.um.edu.my/44953/ High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia Soo, Chun Ian Poon, Khai Vern Ayub, Atiqah You, Hui Wen Tan, Chai Xian Loh, Kenneth Jia Juin Eng, Carolyn Chai Hui Sia, Leng Cheng Wong, Chee Kuan R Medicine Introduction: The use of dexamethasone (DXM) has been associated with decreased mortality in the patients with hypoxemia during the coronavirus disease-2019 (COVID-19) pandemic, while the outcomes with methylprednisolone (MTP) have been mixed. This real-life study aimed to evaluate the outcomes of patients with severe respiratory failure due to COVID-19 who were treated with high doses of MTP. Materials and Methods: This retrospective cohort study enrolled hospitalised patients between May 2021 and August 2021, aged 18 years and above, with severe respiratory failure defined by a ratio of oxygen saturation to fraction of inspired oxygen (SF ratio) of less than 235. The treatment protocol involved administering high-dose MTP for 3 days, followed by DXM, and the outcomes were compared with those of patients who received DXM alone (total treatment duration of 10 days for both groups). Results: A total of 99 patients were enrolled, with 79 (79.8) receiving pulse MTP therapy and 20 (20.2) being treated with DXM only. The SF ratio significantly improved from a mean of 144.49 (±45.16) at baseline to 208 (±85.19) at 72 hours (p < 0.05), with a mean difference of 63.51 (p < 0.001) in patients who received ≤750 mg of MTP. Additionally, in patients who received >750 mg of MTP, the SF ratio improved from a baseline mean of 130.39 (±34.53) to 208.44 (±86.61) at 72 hours (p < 0.05), with a mean difference of 78.05 (p = 0.001). In contrast, patients who received DXM only demonstrated an SF ratio of 132.85 (±44.1) at baseline, which changed minimally to 133.35 (±44.4) at 72 hours (p = 0.33), with a mean difference of 0.50 (p = 0.972). The incidence of nosocomial infection was higher in the MTP group compared with the DXM group (40.5 vs. 35, p = 0.653), with a relative risk of 1.16 (95 CI: 0.60-2.23). Conclusion: MTP did not demonstrate a significant reduction in intubation or intensive care unit admissions. Although a high dose of MTP improved gas exchange in patients with severe and critical COVID-19, it did not provide an overall mortality benefit compared to standard treatment. © 2024, Malaysian Medical Association. All rights reserved. Malaysian Medical Association 2024 Article PeerReviewed Soo, Chun Ian and Poon, Khai Vern and Ayub, Atiqah and You, Hui Wen and Tan, Chai Xian and Loh, Kenneth Jia Juin and Eng, Carolyn Chai Hui and Sia, Leng Cheng and Wong, Chee Kuan (2024) High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia. Medical Journal of Malaysia, 79 (1). 15 – 20. ISSN 0300-5283,
institution	Universiti Malaya
building	UM Library
collection	Institutional Repository
continent	Asia
country	Malaysia
content_provider	Universiti Malaya
content_source	UM Research Repository
url_provider	http://eprints.um.edu.my/
topic	R Medicine
spellingShingle	R Medicine Soo, Chun Ian Poon, Khai Vern Ayub, Atiqah You, Hui Wen Tan, Chai Xian Loh, Kenneth Jia Juin Eng, Carolyn Chai Hui Sia, Leng Cheng Wong, Chee Kuan High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia
description	Introduction: The use of dexamethasone (DXM) has been associated with decreased mortality in the patients with hypoxemia during the coronavirus disease-2019 (COVID-19) pandemic, while the outcomes with methylprednisolone (MTP) have been mixed. This real-life study aimed to evaluate the outcomes of patients with severe respiratory failure due to COVID-19 who were treated with high doses of MTP. Materials and Methods: This retrospective cohort study enrolled hospitalised patients between May 2021 and August 2021, aged 18 years and above, with severe respiratory failure defined by a ratio of oxygen saturation to fraction of inspired oxygen (SF ratio) of less than 235. The treatment protocol involved administering high-dose MTP for 3 days, followed by DXM, and the outcomes were compared with those of patients who received DXM alone (total treatment duration of 10 days for both groups). Results: A total of 99 patients were enrolled, with 79 (79.8) receiving pulse MTP therapy and 20 (20.2) being treated with DXM only. The SF ratio significantly improved from a mean of 144.49 (±45.16) at baseline to 208 (±85.19) at 72 hours (p < 0.05), with a mean difference of 63.51 (p < 0.001) in patients who received ≤750 mg of MTP. Additionally, in patients who received >750 mg of MTP, the SF ratio improved from a baseline mean of 130.39 (±34.53) to 208.44 (±86.61) at 72 hours (p < 0.05), with a mean difference of 78.05 (p = 0.001). In contrast, patients who received DXM only demonstrated an SF ratio of 132.85 (±44.1) at baseline, which changed minimally to 133.35 (±44.4) at 72 hours (p = 0.33), with a mean difference of 0.50 (p = 0.972). The incidence of nosocomial infection was higher in the MTP group compared with the DXM group (40.5 vs. 35, p = 0.653), with a relative risk of 1.16 (95 CI: 0.60-2.23). Conclusion: MTP did not demonstrate a significant reduction in intubation or intensive care unit admissions. Although a high dose of MTP improved gas exchange in patients with severe and critical COVID-19, it did not provide an overall mortality benefit compared to standard treatment. © 2024, Malaysian Medical Association. All rights reserved.
format	Article
author	Soo, Chun Ian Poon, Khai Vern Ayub, Atiqah You, Hui Wen Tan, Chai Xian Loh, Kenneth Jia Juin Eng, Carolyn Chai Hui Sia, Leng Cheng Wong, Chee Kuan
author_facet	Soo, Chun Ian Poon, Khai Vern Ayub, Atiqah You, Hui Wen Tan, Chai Xian Loh, Kenneth Jia Juin Eng, Carolyn Chai Hui Sia, Leng Cheng Wong, Chee Kuan
author_sort	Soo, Chun Ian
title	High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia
title_short	High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia
title_full	High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia
title_fullStr	High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia
title_full_unstemmed	High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia
title_sort	high-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical covid-19 pneumonia: efficacy assessment in a retrospective single-centre experience from malaysia
publisher	Malaysian Medical Association
publishDate	2024
url	http://eprints.um.edu.my/44953/
_version_	1797906861290160128
score	13.211869

High-dose pulse methylprednisolone vs. dexamethasone standard therapy for severe and critical COVID-19 pneumonia: Efficacy assessment in a retrospective single-centre experience from Malaysia

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