Is high-dose glucocorticoid beneficial in COVID-19?

Muthu, Valliappan; Sehgal, Inderpaul Singh; Prasad, Kuruswamy Thurai; Agarwal, Ritesh

We read with interest the article by Edalatifard et al., and we congratulate them for performing a randomised controlled trial (RCT) amidst the ongoing pandemic [1]. We have a few concerns regarding the methods and interpretation of the current study. While the intervention group's mortality is low, the mortality in the control group is disproportionately high for the severity of illness (non-acute respiratory distress syndrome [ARDS], non-intubated). The mortality in ARDS due to coronavirus disease (COVID) 2019 among mechanically ventilated patients is 50% or less, and it has improved over time from 42 to 25% [2, 3]. The mortality in the current study's control arm (43%) was worse than the mortality in the control arm of the RECOVERY trial (26%) [4]. The survival difference between the two study groups may be due to the better supportive care provided to the intervention arm due to the trial's unblinded nature. Also, the justification provided for the sample size is inadequate. The authors have cited studies using methylprednisolone in asthma, COPD, and pre-operative patients as references for the sample size calculation.