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Joshi S, Smith Z, Soman S, Jain S, Yako A, Hojeij M, Massoud L, Alsaadi A, Williams J, Kenney R, Miller J, Alangaden G, Ramesh M. Low- Versus High-Dose Methylprednisolone in Adult Patients With Coronavirus Disease 2019: Less Is More. Open Forum Infect Dis 2022; 9:ofab619. [PMID: 35024376 PMCID: PMC8689728 DOI: 10.1093/ofid/ofab619] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2021] [Accepted: 12/07/2021] [Indexed: 12/15/2022] Open
Abstract
Background Corticosteroids use in severe coronavirus disease 2019 (COVID-19) improves survival; however, the optimal dose is not established. We aim to evaluate clinical outcomes in patients with severe COVID-19 receiving high-dose corticosteroids (HDC) versus low-dose corticosteroids (LDC). Methods This was a quasi-experimental study conducted at a large, quaternary care center in Michigan. A corticosteroid dose change was implemented in the standardized institutional treatment protocol on November 17, 2020. All patients admitted with severe COVID-19 that received corticosteroids were included. Consecutive patients in the HDC group (September 1 to November 15, 2020) were compared to the LDC group (November 30, 2020 to January 20, 2021). High-dose corticosteroids was defined as 80 mg of methylprednisolone daily in 2 divided doses, and LDC was defined as 32–40 mg of methylprednisolone daily in 2 divided doses. The primary outcome was all-cause 28-day mortality. Secondary outcomes included progression to mechanical ventilation, hospital length of stay (LOS), discharge on supplemental oxygen, and corticosteroid-associated adverse events. Results Four-hundred seventy patients were included: 218 (46%) and 252 (54%) in the HDC and LDC groups, respectively. No difference was observed in 28-day mortality (14.5% vs 13.5%, P = .712). This finding remained intact when controlling for additional variables (odds ratio, 0.947; confidence interval, 0.515–1.742; P = .861). Median hospital LOS was 6 and 5 days in the HDC and LDC groups, respectively (P < .001). No differences were noted in any of the other secondary outcomes. Conclusions Low-dose methylprednisolone had comparable outcomes including mortality to high-dose methylprednisolone for the treatment of severe COVID-19.
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Affiliation(s)
- Seema Joshi
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Zachary Smith
- Henry Ford Hospital, Department of Pharmacy, Detroit, Michigan, USA
| | - Sana Soman
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Saniya Jain
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Atheel Yako
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Marwa Hojeij
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Louis Massoud
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Ayman Alsaadi
- Henry Ford Hospital, Department of Internal Medicine, Detroit, Michigan, USA
| | - Jonathan Williams
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Rachel Kenney
- Henry Ford Hospital, Department of Pharmacy, Detroit, Michigan, USA
| | - Joseph Miller
- Henry Ford Hospital, Department of Emergency Medicine, Detroit, Michigan, USA
| | - George Alangaden
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
| | - Mayur Ramesh
- Henry Ford Hospital, Division of Infectious Diseases, Detroit, Michigan, USA
- Correspondence: Mayur Ramesh, MD, Henry Ford Hospital, Division of Infectious Diseases, 2799 W. Grand Blvd., Detroit, MI 48202 USA ()
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