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High-dose methylprednisolone versus dexamethasone therapy for hospitalized patients with severe COVID-19: a retrospective analysis

This study aimed to evaluate the clinical effects of high-dose methylprednisolone therapy in hospitalized patients with severe coronavirus disease (COVID-19) who required oxygen therapy, but not noninvasive/invasive mechanical ventilation or extracorporeal membrane oxygenation therapy. This retrospective observational study that was conducted from April 2021 to October 2021 at a secondary hospital in Japan enrolled patients who were administered 6 mg/day dexamethasone as an initial corticosteroid treatment on admission (dexamethasone group) and those who were administered ≥ 250 mg/day methylprednisolone (methylprednisolone group). Of the 42 participants, 40.5%(17/42) were included in the methylprednisolone group. The incidence of transfer to a tertiary hospital did not differ significantly between the methylprednisolone and dexamethasone groups (5.9% vs. 20%, p = 0.37), and in-hospital mortality was similar in both the groups (0% vs. 4%, p = 1.00). Participants in the methylprednisolone group had a significantly longer duration of oxygen therapy than the dexamethasone group (median (interquartile range) 8.5 (5.5–11.2) days vs. 4 (2.0–7.5) days, p < 0.05). Compared to dexamethasone, high-dose methylprednisolone therapy did not provide any added benefits for patients with severe COVID-19 who did not require respiratory mechanical support.