The progression of the severity of COVID-19 caused by the SARS-Cov-2 virus is through an exaggerated host immune response called the cytokine storm. Corticosteroids can reduce this storm through their anti-inflammatory action, thus preventing lung damage. However the efficacy and side effect profile of the two commonly used corticosteroids- dexamethasone and methylprednisolone against COVID-19 have to be compared, to enable the selection of the appropriate drug with better outcomes. Thus the objective was to compare the efficacy of adjuvant parenteral methylprednisolone and dexamethasone in reducing COVID-19 disease severity and mortality among the moderate to critical patients. MATERIAL: A retrospective comparative study was done among 162 adult patients who were COVID-19 RTPCR positive with moderate or severe illness, among whom 100 patients had received parenteral dexamethasone and 62 patients had received parenteral methylprednisolone. The radiological changes, inflammatory markers and outcomes -duration of hospital stay, rate of discharges, deaths improvement in oxygen requirement, blood glucose post steroids were compared between the two groups. The same parameters were compared for duration of either steroid of less than five days and more than five days respectively. OBSERVATION: Both corticosteroids had a significant improvement in the inflammatory markers of serum LDH, D-Dimer and CRP (p<0.001) with a significant improvement in D-Dimer levels in the methylprednisolone group compared to the dexamethasone group (p =0.04). Methylprednisolone was found to have significant improvement in the oxygen requirement (p=0.01), disease severity (p= 0.015) and radiological changes (p=0.002) compared to dexamethasone. Both corticosteroids were associated with an increase in blood glucose levels post treatment, but no significant difference in the glucose levels between the two groups (p=0.469). No significant difference was seen in the outcomes on comparing the duration of steroids of either group for less than five days with a duration of more than five days. CONCLUSION: Parenteral Methylprednisolone is associated with a better improvement in the severity of moderate and severe COVID-19 compared to dexamethasone. Both steroids cause a similar increase in blood glucose levels, indicating that either steroid holds the risk of hyperglycemia and its potential complications. A longer duration of steroids is not associated with a significant difference in outcome compared to shorter duration of steroids, it also has a hyperglycemia risk similar to the latter.
A Comparison of the Efficacy of Adjuvant Parenteral Methylprednisolone and Dexamethasone in Reducing Covid-19 Disease Severity and Mortality among the Moderate to Critical Patients -A Retrospective Study