Azemi Nur Fatin Najwa, Islahudin Farida, Khan Rahela Ambaras, Saffian Shamin Mohd, Loon Leong Chee
Centre for Quality Management of Medicines, Faculty of Pharmacy, University Kebangsaan Malaysia, Kuala Lumpur, Malaysia.
Department of Pharmacy, Hospital Kuala Lumpur, Kuala Lumpur, Malaysia.
J Pharm Policy Pract. 2024 Apr 17;17(1):2337125. doi: 10.1080/20523211.2024.2337125. eCollection 2024.
Trials have demonstrated the benefits of methylprednisolone in the treatment of coronavirus disease 2019 (COVID-19). However, data on optimal dose, duration and timing of administration are limited. This study investigates the outcome of various methylprednisolone treatment regimens among hospitalised COVID-19 patients.
A retrospective cohort study was conducted on hospitalised adult COVID-19 patients admitted between June and August 2021 in general COVID-19 wards, treated with methylprednisolone. Clinical outcomes evaluated include in-hospital mortality, thirty-day mortality, clinical efficacy (C-reactive protein (CRP), total white blood cells (TWBC) and oxygen requirement) as well as the safety of methylprednisolone.
Of 278 patients, 1(0.4%) received weight-based dosing of 1 mg/kg/day, 101(36.3%) received weight-based dosing of 2 mg/kg/day, 130(46.8%) received fixed dosing methylprednisolone 250 mg/day and 46(16.5%) received fixed dosing methylprednisolone 500 mg/day. There was a significant difference in in-hospital mortality rates following different methylprednisolone doses whereby in-hospital mortality occurred in 22.5% (n = 23) of patients with 1 or 2 mg/kg/day methylprednisolone, 32.3% (n = 42) with 250 mg/day and 39.1% (n = 18) with 500 mg/day ( = 0.023). On the other hand, no significant difference in thirty-day mortality, clinical efficacy and safety was observed between different dosing regimens ( > 0.05).
The use of methylprednisolone weight-based dosing in hospitalised COVID-19 patients should be considered due to the positive outcome associated with lower in-hospital mortality.
试验已证明甲泼尼龙在治疗2019冠状病毒病（COVID-19）方面的益处。然而，关于最佳剂量、持续时间和给药时机的数据有限。本研究调查了住院COVID-19患者中各种甲泼尼龙治疗方案的结果。
对2021年6月至8月期间在普通COVID-19病房住院并接受甲泼尼龙治疗的成年COVID-19患者进行了一项回顾性队列研究。评估的临床结果包括住院死亡率、30天死亡率、临床疗效（C反应蛋白（CRP）、总白细胞（TWBC）和氧气需求）以及甲泼尼龙的安全性。
278例患者中，1例（0.4%）接受基于体重的1mg/kg/天给药，101例（36.3%）接受基于体重的2mg/kg/天给药，130例（46.8%）接受固定剂量甲泼尼龙250mg/天，46例（16.5%）接受固定剂量甲泼尼龙500mg/天。不同甲泼尼龙剂量后的住院死亡率存在显著差异，接受1或2mg/kg/天甲泼尼龙的患者中有22.5%（n=23）发生住院死亡，接受250mg/天的患者中有32.3%（n=42），接受500mg/天的患者中有39.1%（n=18）（P=0.023）。另一方面，不同给药方案之间在30天死亡率、临床疗效和安全性方面未观察到显著差异（P>0.05）。
鉴于基于体重给药的甲泼尼龙与较低的住院死亡率相关的积极结果，应考虑在住院COVID-19患者中使用。
