Is methylprednisolone better than dexamethasone for severe COVID-19?

Dexamethasone prevents some deaths among hypoxaemic patients with COVID-19. However, methylprednisolone achieves higher lung tissue concentrations than dexamethasone, raising questions about whether it would be more effective.

Iranian investigators randomised 86 adults with confirmed SARS-CoV-2 infection who were hospitalised (with oxygen saturation ≤92% on room air) to receive either intravenous methylprednisolone (2 mg/kg daily dose tapered after 5 days; total dosing, 10 days) or intravenous dexamethasone (6 mg daily for 10 days).

Based on the World Health Organisation's Ordinal Scale for Clinical Improvement (OSCI), patients who received methylprednisolone had significantly greater clinical improvement than patients who received dexamethasone.

Although it is not clear if these study results are due to the type of steroid and its improved lung penetration or to the higher relative dose of methylprednisolone prescribed, this approach could be considered in patients with severe COVID-19.