High‐dose methylprednisolone in nonintubated patients with severe COVID‐19 pneumonia

Papamanoli, Aikaterini; Yoo, Jeanwoo; Grewal, Prabhjot; Predun, William; Hotelling, Jessica; Jacob, Robin; Mojahedi, Azad; Skopicki, Hal A.; Mansour, Mohamed; Marcos, Luis A.; Kalogeropoulos, Andreas P.

BACKGROUND: Recent trials with dexamethasone and hydrocortisone have demonstrated benefit in patients with coronavirus disease 2019 (COVID‐19). Data on methylprednisolone are limited. METHODS: Retrospective cohort of consecutive adults with severe COVID‐19 pneumonia on high‐flow oxygen (FiO(2) ≥ 50%) admitted to an academic centre in New York, from 1 March to 15 April 2020. We used inverse probability of treatment weights to estimate the effect of methylprednisolone on clinical outcomes and intensive care resource utilization. RESULTS: Of 447 patients, 153 (34.2%) received methylprednisolone and 294 (65.8%) received no corticosteroids. At 28 days, 102 patients (22.8%) had died and 115 (25.7%) received mechanical ventilation. In weighted analyses, risk for death or mechanical ventilation was 37% lower with methylprednisolone (hazard ratio 0.63; 95% CI 0.47‐0.86; P = .003), driven by less frequent mechanical ventilation (subhazard ratio 0.56; 95% CI 0.40‐0.79; P = .001); mortality did not differ between groups. The methylprednisolone group had 2.8 more ventilator‐free days (95% CI 0.5‐5.1; P = .017) and 2.6 more intensive care‐free days (95% CI 0.2‐4.9; P = .033) during the first 28 days. Complication rates were not higher with methylprednisolone. CONCLUSIONS: In nonintubated patients with severe COVID‐19 pneumonia, methylprednisolone was associated with reduced need for mechanical ventilation and less‐intensive care resource utilization without excess complications.