Methylprednisolone versus dexamethasone in hospitalized patients with severe COVID-19: a systematic review and meta-analysis of randomized controlled trials.

BACKGROUND

The aim of this systematic review was to compare the efficacy of methylprednisolone and dexamethasone in severe COVID-19 hospitalized patients.

METHODS

We conducted systematic searches of MEDLINE, Embase, the Cochrane Library, and clinicaltrials.gov without language restrictions. Randomized controlled trials (RCTs) on the treatment of severe COVID-19 with methylprednisolone, compared with dexamethasone, were included. Findings were summarized as risk ratios (RR) and mean differences (MD) with 95% confidence intervals (CI). The certainty of evidence was assessed using the GRADE (Grading of Recommendations, Assessment, Development, and Evaluations) framework, categorized as "high," "moderate," "low," or "very low" quality.

RESULTS

Five RCTs (enrolling 1102 participants) met the inclusion criteria. There was no statistically significant difference in 28-day mortality (RR 0.81, 95% CI 0.58 to 1.14; GRADE = high), length of hospital stay (MD 0.67 days, 95% CI -1.77 to 3.10 days; moderate), intensive care unit (ICU) admission (RR 1.20, 95% CI 0.85 to 1.69; high), and invasive ventilation (RR 0.87, 95% CI 0.42 to 1.79; high) between the two groups. Overall, using the GRADE framework, 3 pooled analyses were rated as high quality, with 1 rated as moderate quality.

CONCLUSIONS

Methylprednisolone demonstrated similar therapeutic effects compared to dexamethasone in hospitalized patients with severe COVID-19.