The comparative effectiveness of methylprednisolone versus dexamethasone on in-hospital mortality in patients with severe or critical COVID-19: a retrospective observational study

Background: Studies comparing the effectiveness of dexamethasone versus methylprednisolone for treating severe-to-critical COVID-19 have produced conflicting results. This study aimed to evaluate the impact of dexamethasone compared with methylprednisolone on in-hospital mortality among patients with severe or critical COVID-19. Objectives: The objective of this study was to assess the effectiveness of dexamethasone in comparison to methylprednisolone in reducing in-hospital mortality in patients suffering from severe-to-critical COVID-19 pneumonia. Design: This was a retrospective observational study conducted at a tertiary care academic medical center. Methods: Clinical data from 706 hospitalized patients with severe or critical COVID-19 in Karachi, Pakistan, were reviewed. Of these patients, 217 received either oral or intravenous dexamethasone, and 393 were treated with methylprednisolone. The primary outcome was in-hospital mortality, while secondary outcomes included the length of hospitalization and the need for mechanical ventilation. Results: The methylprednisolone group had a male predominance (74% vs 54%; p < 0.001). However, there was no significant difference in median age between the dexamethasone group (55 years) and the methylprednisolone group (57 years) (p = 0.09). Mortality was significantly higher in the methylprednisolone group compared to the dexamethasone group (13.7% vs 3.2%, p < 0.001). Multivariable analysis showed that dexamethasone was associated with lower in-hospital mortality (adjusted odds ratio (aOR): 0.24; 95% CI: 0.09–0.62; p = 0.003). Furthermore, patients in the dexamethasone group had a shorter length of hospital stay (aOR: 0.87 (95% CI: 0.82–0.92)) compared to the methylprednisolone group. A higher proportion of patients required invasive mechanical ventilation in the methylprednisolone group compared to the dexamethasone group (13.7% vs 3.2%; p < 0.001). Conclusion: Dexamethasone was associated with lower mortality and a reduced length of hospital stay and a lower proportion of patients required mechanical ventilation compared to methylprednisolone in patients with severe-to-critical COVID-19.