Department of Pharmacy, School of Applied Sciences, University of Huddersfield, Huddersfield, UK.
School of Postgraduate Studies, International Medical University, Kuala Lumpur, Malaysia.
Expert Rev Respir Med. 2021 Aug;15(8):1049-1055. doi: 10.1080/17476348.2021.1925546. Epub 2021 Jul 2.
: The question remained if mortality benefits with dexamethasone seen in patients with coronavirus disease 2019 (COVID-19) also extend to other systemic corticosteroids such as methylprednisolone. This article presents a meta-analysis of randomized controlled trials (RCTs) to ascertain if methylprednisolone can be recommended for use in patients with COVID-19 to prevent deaths.: Systematic literature search was performed in PubMed, Scopus, Cochrane Central Register of Controlled Trials, and preprint servers until 13 April 2021. The outcome of interest was all-cause mortality. The random-effects model for the meta-analysis was utilized to estimate the pooled odds ratio (OR) at 95% confidence intervals (CI).: Five RCTs were included in the meta-analysis. The pooled OR for all-cause mortality was 0.64 (95% CI: 0.29 - 1.43, = 652) comparing methylprednisolone with the control, indicating no mortality benefits. A similar finding was noted with a sub-group analysis including four trials that used low-dose methylprednisolone. However, the only trial that administered high dose methylprednisolone indicated a statistically significant mortality benefit (OR 0.08, 95% CI: 0.02-0.42).: In determining equipotent doses for an acute short-course pulse therapy of corticosteroids, the biological half-life of steroids should also be accounted for besides the potency factor. A short duration (3-5 days) pulse therapy of high-dose methylprednisolone can be a promising alternative to the low-dose dexamethasone therapy in severely ill patients with COVID-19 to prevent deaths.
: 问题仍然是，在 2019 年冠状病毒病（COVID-19）患者中看到的地塞米松的死亡率益处是否也扩展到其他全身性皮质类固醇，如甲泼尼龙。本文对随机对照试验（RCT）进行了荟萃分析，以确定甲泼尼龙是否可推荐用于 COVID-19 患者，以预防死亡。: 系统地在 PubMed、Scopus、Cochrane 对照试验中心注册库和预印本服务器中进行文献检索，直到 2021 年 4 月 13 日。主要结局是全因死亡率。采用随机效应模型进行荟萃分析，以估计汇总优势比（OR）的 95%置信区间（CI）。: 荟萃分析纳入了 5 项 RCT。与对照组相比，使用甲泼尼龙的全因死亡率的汇总 OR 为 0.64（95%CI：0.29-1.43， = 652），表明无死亡率益处。对包括四项使用低剂量甲泼尼龙的试验的亚组分析也发现了类似的结果。然而，唯一一项给予大剂量甲泼尼龙的试验表明死亡率有统计学显著益处（OR 0.08，95%CI：0.02-0.42）。: 在确定皮质类固醇急性短期冲击疗法的等效剂量时，除了效力因素外，还应考虑类固醇的生物半衰期。高剂量甲泼尼龙的短疗程（3-5 天）脉冲疗法可能是 COVID-19 重症患者低剂量地塞米松治疗的有前途的替代方案，以预防死亡。
