Abstract
Background: The severe coronavirus disease 2019 (COVID-19) induces widespread inflammatory responses that are attempted to be managed by the administration of anti-inflammatory drugs, along with antiviral drugs and respiratory support. This clinical trial study investigated the effect of short-term and low-dose methylprednisolone on the clinical outcome and radiological improvement of admitted patients with severe COVID-19.
Methods: In this randomized clinical trial, two strains of patients with severe pneumonia of COVID-19 were evaluated before and after the use of corticosteroids. Inclusion criteria were age over 18 years, definitive case of COVID-19 based on positive reverse transcription polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 (SARS-COV-2), and arterial oxygen saturation (SaO2 )<93%; furthermore, at least 7 days and 5 days should be passed since the onset of symptoms and antiviral treatment, respectively. Exclusion criteria were similar to contraindications to the administration of methylprednisolone for short-term injections and pregnancy. Patients received intravenous methylprednisolone succinate (1-1.75 mg/kg/day) for 5 days in addition to treatment based on the World Health Organization (WHO) approved protocol for COVID-19. Finally, demographic characteristics, dyspnea, peripheral oxygen saturation (SpO2), number of lymphocytes, and computed tomography (CT) scan of the patient’s chest before and after taking corticosteroids were evaluated.
Results: The average oxygen saturation of patients increased significantly after taking methylprednisolone succinate (P<0.001). Moreover, dyspnea and pulmonary insufficiency in CT scans improved significantly (P<0.001), and among hematological parameters, only lymphocytes increased significantly (P=0.01). Furthermore, methylprednisolone succinate use had no effect on mortality and length of hospitalization.
Conclusion: Methylprednisolone succinate use during the treatment period of COVID-19 improves clinical conditions, CT scan findings, and hematological parameters affected by inflammation, but it does not affect the mortality and length of hospitalization of patients.