Haratian Kaveh, Alaei Arsalan, Mehrpoor Golbarg, Gargari Omid Kohandel
Department of Pathology and Laboratory Medicine, Western University, London, ON, Canada.
Department of General Surgery, Tehran University of Medical Sciences, Tehran, Iran.
Virol J. 2025 Aug 6;22(1):270. doi: 10.1186/s12985-025-02906-4.
COVID-19, caused by SARS-CoV-2, leads to severe respiratory complications, often requiring intensive care. Corticosteroids have been widely used to manage inflammation in COVID-19 patients, with dexamethasone and methylprednisolone being among the most commonly administered options. However, their relative efficacy remains a subject of debate. This study aimed to compare the effectiveness of dexamethasone and methylprednisolone in hospitalized COVID-19 patients.
This double-blind, randomized controlled trial was conducted at Imam-Ali Hospital, Karaj, Iran, on 300 hospitalized COVID-19 patients. Patients were randomly assigned to receive either intravenous dexamethasone (8 mg twice daily) or pulse methylprednisolone (500 mg daily for three days), in addition to standard COVID-19 management. The primary outcomes included mortality rate, ICU length of stay, and the need for mechanical ventilation. Secondary outcomes involved blood oxygen saturation (SpO₂) levels. Statistical analyses were performed using SPSS (version 26).
The study included 150 patients in each treatment group. The mortality rate was 12.6% in the dexamethasone group and 15.3% in the methylprednisolone group, with no statistically significant difference (RR: 0.82, P = 0.50). The need for mechanical ventilation was observed in 16.6% of patients in the dexamethasone group and 21.3% in the methylprednisolone group, also without a significant difference (RR: 0.78, P = 0.30). However, ICU stay was significantly shorter in the dexamethasone group (9.5 days) compared to the methylprednisolone group (11.3 days) (P < 0.001). No significant differences were noted in SpO₂ levels between the two groups.
Both dexamethasone and methylprednisolone demonstrated similar efficacy in outcomes such as mortality rate need for mechanical ventilation in hospitalized COVID-19 patients. However, dexamethasone was associated with a significantly shorter ICU stay, suggesting a potential advantage in hospitalization duration. Further research is needed to refine corticosteroid use and explore additional immunomodulatory strategies to improve COVID-19 outcomes.
由严重急性呼吸综合征冠状病毒2（SARS-CoV-2）引起的2019冠状病毒病（COVID-19）会导致严重的呼吸并发症，常常需要重症监护。皮质类固醇已被广泛用于治疗COVID-19患者的炎症，地塞米松和甲泼尼龙是最常用的药物。然而，它们的相对疗效仍是一个有争议的话题。本研究旨在比较地塞米松和甲泼尼龙对住院COVID-19患者的疗效。
这项双盲、随机对照试验在伊朗卡拉季的伊玛目阿里医院对300例住院COVID-19患者进行。除了标准的COVID-19治疗外，患者被随机分配接受静脉注射地塞米松（每日两次，每次8毫克）或冲击剂量甲泼尼龙（每日500毫克，共三天）。主要结局包括死亡率、重症监护病房（ICU）住院时间和机械通气需求。次要结局涉及血氧饱和度（SpO₂）水平。使用SPSS（版本26）进行统计分析。
每个治疗组纳入150例患者。地塞米松组的死亡率为12.6%，甲泼尼龙组为15.3%，差异无统计学意义（风险比：0.82，P = 0.50）。地塞米松组16.6%的患者需要机械通气，甲泼尼龙组为21.3%，差异也无统计学意义（风险比：0.78，P = 0.30）。然而，与甲泼尼龙组（11.3天）相比，地塞米松组的ICU住院时间显著更短（9.5天）（P < 0.001）。两组之间的SpO₂水平无显著差异。
地塞米松和甲泼尼龙在住院COVID-19患者的死亡率和机械通气需求等结局方面显示出相似的疗效。然而，地塞米松与显著更短的ICU住院时间相关，表明在住院时长方面具有潜在优势。需要进一步研究以优化皮质类固醇的使用，并探索其他免疫调节策略以改善COVID-19的治疗结局。
