Dexamethasone Vs Methylprednisolone In COVID-19 Treatment: Which Drug Is Better?

Dexamethasone

What Is Dexamethasone?

Dexamethasone is a steroid that belongs to the corticosteroid class (especially glucocorticoid) with potent anti-inflammatory properties. It is a synthetic member of the class of glucocorticoids. Dexamethasone is used to treat various conditions such as endocrine, collagen, rheumatic, allergic, dermatologic, gastrointestinal, ophthalmic, respiratory, neoplastic, hematologic and edematous. [1]

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Dexamethasone And COVID-19

According to a study by Oxford University, dexamethasone can reduce the death rate by around one-third in hospitalised COVID-19 patients with severe respiratory complications.

The clinical trial was started in March 2020 on over 11500 patients from around 175 NHS hospitals in the UK. A total of 2104 patients received the drug at a dose of 6 mg a day for ten days, either intravenously or by mouth. Around 4321 patients received usual care alone.

When the results were compared between the patients who received dexamethasone and those who were just given usual care, it was found that the 28-day mortality rate was highest in the latter compared to the prior.

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The mortality rate was higher by 41 per cent in those who required ventilation, 25 per cent in those who required oxygen while 13 per cent in those who did not require any respiratory intervention.

Dexamethasone can reduce the death rate in ventilated patients by one-third and in patients receiving oxygen only by one-fifth. No benefit was seen in patients who do not require respiratory support. [2]

Therefore, the results show that dexamethasone can prevent one death among 8 ventilated patients or 25 oxygen-requiring patients.

Methylprednisolone

What Is Methylprednisolone?

Methylprednisolone is another medication that belongs to the systemic corticosteroid class. The drug is used clinically for many anti-inflammatory and immunosuppressive activities. Methylprednisolone has a great utility in pulmonology, dermatology, gastroenterology, endocrinology, neurology, nephrology and haematology. It also has minimal mineralocorticoid activities like dexamethasone. [3]

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Methylprednisolone And COVID-19

A study published in Open Forum Infectious Diseases in September 2020 has shown that prolonged administration of a low dose of methylprednisolone in COVID-19 patients with pneumonia can help decrease the need for ICU admission and mortality. [4]

In a study, 16 per cent of hospitalised COVID-19 patients have developed acute respiratory failure, which leads to ICU admission and weeks of mechanical ventilation support.

Methylprednisolone provides an alternative method that can largely decrease the dependence on ventilators and thus, promote the resolution of severe respiratory problems and decrease the mortality rate due to COVID-19 infection.

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The study was carried out on 173 severe COVID-19 patients with pneumonia admitted to one out of 14 respiratory high-dependency units (RHDUs) in Italy between 27 February and 24 April 2020.

Methylprednisolone was given to 83 patients at a dose of 80 mg intravenously while 90 patients were left untreated.

As per the results, patients who were given methylprednisolone had a 28-day lower risk of all-cause mortality compared to those who were not given the drug.

A reduction of 71 per cent in the risk of death was observed while 7.5 days median reduction in patients transferred to the ICU.

How Do Dexamethasone And Methylprednisolone Work?

Dexamethasone and methylprednisolone have immunosuppressive activities and anti-inflammatory effects (with weak mineralocorticoid property), compared to other nonsteroidal anti-inflammatory drugs such as aspirin and ibuprofen that only inhibits inflammation. [5]

It inhibits a pro-inflammatory gene, a gene type that is responsible for triggering inflammation. At low doses, both medicines can effectively enter the target cells and reduce inflammation associated with COVID-19 such as lung injury, pneumonia or ARDS, with minimal or zero side effects.

On the other hand, these drugs suppress the adaptive immune response, which is beneficial to prevent damage to vital systems in the body. This is because our immune system sometimes gets overactive due to increased viral load and attacks our own body cells. To calm thiseffect on hospitalised patients, these medicines are suggested. [6]

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Dexamethasone Vs Methylprednisolone

In a controlled trial conducted on 86 hospitalised COVID-19 patients in Iran, 42 patients received dexamethasone (6 mg/day) and 44 received methylprednisolone (2 mg/kg/day). [7]

As per the results, methylprednisolone showed better results in terms of hospitalisation duration, low dose and better results, need for mechanical ventilation, better penetration of the drug in the lungs, and lower mortality rates and higher survival times compared to those who received the other drug.

However, dexamethasone can act as a better immunosuppressive agent in treating severe COVID-19 patients to improve their respiratory complications to a large extent compared to methylprednisolone.

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Though the patients suffered from certain complications such as superimposed infection, high blood glucose and immunosuppression due to the administration of these glucocorticoids, the results were more in favour of methylprednisolone compared to dexamethasone in treating hospitalised COVID-19 patients suffering from COVID-19 pneumonia.

However, another study based on their comparison has shown that patients in both the groups have experienced marked improvement in oxygen requirement, temperature and C-reactive protein, thus saying that both the drugs are equally effective in treating COVID-19 infection in both moderate to severe patients. [8]

To Conclude

Dexamethasone and methylprednisolone are two glucocorticoids that may help lower inflammation and complications to a large extent in hospitalised COVID-19 patients and thus, save the lives of many. However, depending on the severity of the condition and other criteria of the drug administration, they are prescribed to the patients by medical experts.