The following is a summary of “Intravenous methylprednisolone pulses in hospitalised patients with severe COVID-19 pneumonia: a double-blind, randomised, placebo-controlled trial” published in the October 2022 issue of Respiratory by Salvarani et al.


When hyperinflammation was caused by coronavirus disease, pulse glucocorticoid therapy was used (COVID-19). Researchers looked at how well pulse intravenous methylprednisolone worked with standard treatment for COVID-19 pneumonia and how safe it was. In this multicenter, randomized, double-blind, placebo-controlled trial, 304 hospitalized patients with COVID-19 pneumonia were given either 1 g of methylprednisolone intravenously for three days in a row or a placebo instead of the standard dose of dexamethasone.

The primary outcome was the length of time a patient had to stay in the hospital. This was calculated as the time between randomization and leaving the hospital without extra oxygen. Survival without invasive ventilation with an orotracheal tube and overall survival was the most important secondary outcomes. Overall, 112 (75.4%) of the 151 patients in the pulse methylprednisolone arm and 111 (75.2%) of the 150 patients in the placebo arm were able to leave the hospital without oxygen 30 days after they were given treatment. In both groups, the median time to discharge was about the same: 15 days (95% CI: 13.0–17.0 days) and 16 days (95% CI: 13.8–18.2 days; hazard ratio (HR): 0.92 (95% CI: 0.71–1.20; P=0.528).

No significant differences were found between the pulse methylprednisolone and placebo arms in terms of admission to the ICU with orotracheal intubation or death (20% vs. 16.1%; HR 1.26, 95% CI 0.74–2.16; P=0.176) or overall mortality (10% vs. 12.2%; HR 0.83, 95% CI 0.42–1.64; P=0.584). Serious side effects happened about the same number of times in both groups. When added to dexamethasone, pulse therapy with methylprednisolone did not help people with COVID-19 pneumonia.

Source: erj.ersjournals.com/content/60/4/2200025