Comparative study on the efficacy and safety of dexamethasone and methylprednisolone for severe COVID-19

doi:10.5246/jcps.2025.04.026

Abstract

Abstract:

Glucocorticoids are widely utilized for treating various immune and inflammation-related diseases, prompting significant interest in their potential application for COVID-19 treatment. This study explored the efficacy and safety of dexamethasone (DEX) and methylprednisolone (MP) in treating severe COVID-19. A cohort of 94 adult patients, aged 18 years and older, with severe COVID-19 was recruited. They received intravenous MP (40–80 mg/d) or DEX (5–10 mg/d) for 7–10 d. The primary objective was to assess the effects of these treatments on mortality rates. Additionally, the study aimed to compare the impact of these medications on various parameters, including the oxygenation index, inflammatory index, fungal infections, and hyperglycemia, serving as secondary endpoints. The findings revealed no fatalities in either group. However, there was one case of pulmonary fibrosis and Aspergillus fumigatus infection in the DEX group, and two cases of Aspergillus infection in the MP group. Although the differences were not statistically significant (P > 0.05), the MP group showed a faster improvement in blood oxygen saturation compared to the DEX group, with a median time of 5 d vs 7 d. No statistically significant difference was observed between the two groups regarding improvement in C-reactive protein levels (P > 0.05). Notably, DEX was associated with a higher incidence of hyperglycemia compared to MP (P < 0.05). Both DEX and MP significantly reduced mortality rates among patients with severe COVID-19 and improved blood oxygen saturation and inflammatory markers. However, MP exhibited a more rapid onset of efficacy and fewer adverse reactions.

Key words: COVID-19, Dexamethasone (DEX), Methylprednisolone (MP), Mortality rate, Inflammatory mediators, Fungal infection, Hyperglycemia

Supporting:

Zengqiang Liu, Wen Liu, Fanfan Xu. Comparative study on the efficacy and safety of dexamethasone and methylprednisolone for severe COVID-19[J]. Journal of Chinese Pharmaceutical Sciences, 2025, 34(4): 345-353.

Figures/Tables 6

Table 1. Comparisons of the DEX and MP groups in terms of baseline data.

Table 2. Comparisons of the DEX and MP groups in terms of heart rate and respiratory rate.

Table 3. Comparisons of the DEX and MP groups in terms of PaO2.

Table 4. Comparisons of the DEX and MP groups in terms of inflammatory mediators.

Table 5. Comparisons of the DEX and MP groups in terms of adverse reactions.

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