BACKGROUND: Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID-19) Data on methylprednisolone are limited METHODS: Retrospective cohort of consecutive adults with severe COVID-19 pneumonia on high-flow oxygen (FiO(2) ≥50%) admitted to an academic center in New York, from March 1 to April 15, 2020 We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resources utilization RESULTS: Of 447 patients, 153 (34 2%) received methylprednisolone and 294 (65 8%) received no corticosteroids At 28 days, 102 patients (22 8%) had died and 115 (25 7%) received mechanical ventilation In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0 63;95%CI 0 47-0 86;P=0 003), driven by less frequent mechanical ventilation (subhazard ratio 0 56;95%CI 0 40-0 79;P=0 001);mortality did not differ between groups The methylprednisolone group had 2 8 more ventilator-free days (95%CI 0 5-5 1;P=0 017) and 2 6 more intensive care-free days (95%CI 0 2-4 9;P=0 033) during the first 28 days Complications rates were not higher with methylprednisolone CONCLUSIONS: In nonintubated patients with severe COVID-19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less intensive care resources utilization without excess complications
High-Dose Methylprednisolone in Nonintubated Patients with Severe COVID-19 Pneumonia