Bangalore Medical College and Research Institute, Bangalore.
J Assoc Physicians India. 2022 Apr;70(4):11-12.
UNLABELLED: The progression of the severity of COVID-19 caused by the SARS-Cov-2 virus is through an exaggerated host immune response called the cytokine storm. Corticosteroids can reduce this storm through their anti-inflammatory action, thus preventing lung damage. However the efficacy and side effect profile of the two commonly used corticosteroids- dexamethasone and methylprednisolone against COVID-19 have to be compared, to enable the selection of the appropriate drug with better outcomes. Thus the objective was to compare the efficacy of adjuvant parenteral methylprednisolone and dexamethasone in reducing COVID-19 disease severity and mortality among the moderate to critical patients. MATERIAL: A retrospective comparative study was done among 162 adult patients who were COVID-19 RTPCR positive with moderate or severe illness, among whom 100 patients had received parenteral dexamethasone and 62 patients had received parenteral methylprednisolone. The radiological changes, inflammatory markers and outcomes -duration of hospital stay, rate of discharges, deaths improvement in oxygen requirement, blood glucose post steroids were compared between the two groups. The same parameters were compared for duration of either steroid of less than five days and more than five days respectively. OBSERVATION: Both corticosteroids had a significant improvement in the inflammatory markers of serum LDH, D-Dimer and CRP (p<0.001) with a significant improvement in D-Dimer levels in the methylprednisolone group compared to the dexamethasone group (p =0.04). Methylprednisolone was found to have significant improvement in the oxygen requirement (p=0.01), disease severity (p= 0.015) and radiological changes (p=0.002) compared to dexamethasone. Both corticosteroids were associated with an increase in blood glucose levels post treatment, but no significant difference in the glucose levels between the two groups (p=0.469). No significant difference was seen in the outcomes on comparing the duration of steroids of either group for less than five days with a duration of more than five days. CONCLUSION: Parenteral Methylprednisolone is associated with a better improvement in the severity of moderate and severe COVID-19 compared to dexamethasone. Both steroids cause a similar increase in blood glucose levels, indicating that either steroid holds the risk of hyperglycemia and its potential complications. A longer duration of steroids is not associated with a significant difference in outcome compared to shorter duration of steroids, it also has a hyperglycemia risk similar to the latter.
目的:比较辅助性静脉内甲基泼尼松龙和地塞米松在降低中重度 COVID-19 患者疾病严重程度和死亡率方面的疗效。
材料:对 162 例 COVID-19 RT-PCR 阳性、中度或重度疾病的成年患者进行回顾性对比研究,其中 100 例患者接受了静脉内地塞米松治疗,62 例患者接受了静脉内甲基泼尼松龙治疗。比较两组患者的影像学改变、炎症标志物和结局[住院时间、出院率、死亡率、氧需求改善、类固醇后血糖]。比较两组患者中类固醇使用时间少于 5 天和多于 5 天的上述参数。
观察:两种皮质类固醇均显著改善血清 LDH、D-二聚体和 CRP 的炎症标志物(p<0.001),与地塞米松组相比,甲基泼尼松龙组 D-二聚体水平显著改善(p =0.04)。与地塞米松相比,甲基泼尼松龙组氧需求(p=0.01)、疾病严重程度(p=0.015)和影像学改变(p=0.002)显著改善。两种皮质类固醇均与治疗后血糖升高有关,但两组间血糖无显著差异(p=0.469)。比较两组患者类固醇使用时间少于 5 天与多于 5 天的结局,差异无统计学意义。
结论:与地塞米松相比,静脉内甲基泼尼松龙治疗中重度 COVID-19 严重程度的改善更好。两种类固醇均会导致血糖水平相似升高,表明两种类固醇均存在发生高血糖及其潜在并发症的风险。与较短的类固醇使用时间相比,较长的类固醇使用时间与结局无显著差异,且与后者一样存在发生高血糖的风险。