Efficacy of Dexamethasone and Methylprednisolone in COVID-19 Pneumonia Patients in Kolkata, India: A Retrospective Cohort Study

Abstract

Introduction: Since the outbreak of Coronavirus Disease 2019 (COVID-19) in China, the epidemic has rapidly spread all over the world in just a few months. Different steroids have been proven effective in treating COVID-19 pneumonia. However, comparative efficacy data between different steroids have been evaluated in a few studies from various parts of the world. To date, no study with a large number of patients has been conducted in the eastern part of India. Aim: To compare the efficacy of dexamethasone and methylprednisolone in terms of outcomes and disease progression in COVID-19 pneumonia patients. Materials and Methods: This retrospective cohort study included 377 patients with moderate and severe COVID-19 pneumonia admitted to Medical College and Hospital from May 2020 to December 2020, Kolkata, West Bengal, India. Patient records were divided into two groups based on the type of steroids administered (dexamethasone and methylprednisolone). Clinical, laboratory, treatment, and outcome data were tabulated for analysis. Demographic patterns in the two groups were compared, and efficacy was analysed in terms of hospital course (hospital stay length, type of respiratory support received) and final outcome (cured or death) in both groups. The data collected were analysed using Statistical Package for Social Sciences (SPSS) software version 29.0. Qualitative variables were expressed as counts and percentages, while quantitative variables were presented as mean±Standard Deviation (SD). Results: There were no significant differences between the two treatment groups based on demographic features (age, sex), co-morbidities (diabetes, hypertension, etc.), disease severity (hypoxia, hypotension) on admission day, and smoking status. The study showed that methylprednisolone significantly reduced the requirement for high-flow oxygen (p-value=0.002), Non Invasive Ventilation (NIV) (p-value=0.001), and invasive ventilation (p-value=0.001) compared to dexamethasone. However, there was no significant difference (p-value=0.800) in the duration of hospital stay between the methylprednisolone and dexamethasone treatment groups. Kaplan-Meier survival analysis also showed a significant survival benefit among patients who received methylprednisolone compared to dexamethasone (log-rank p-value=0.039). Conclusion: The present study concludes that in COVID-19 pneumonia, the administration of methylprednisolone leads to a significant reduction in mortality and the need for high-flow oxygen, NIV, and invasive ventilation compared to dexamethasone.

Keywords

• co-morbidity
• coronavirus disease-2019
• efficacy
• steroids