IV methylprednisolone pulse treatment for hospitalised severe COVID-19

Results from a small single-blind randomised study using an immune suppressing treatment in severe COVID-19 published in ERJ reported benefits from reducing respiratory inflammation.

From April to June 2020, the study randomised 64 adults hospitalised with COVID-19 and at an early stage of pulmonary illness (before mechanical oxygen), to add methylprednisolone pulse therapy (250 mg/day IV for 3 days) to standard of care (hydroxychloroquine, lopinavir and naproxen) or to standard of care alone. However, six participants in the control group were also given methylprednisolone and were excluded from the ITT analysis.

Significant benefits were reported for the active arm for the primary endpoints of clinical progression (94% vs 57%) and mortality (5·9% vs 42.9%; p <0·001). Increased survival time by Kaplan-Meier estimates was also reported to benefit the active arm: HR: 0.293 (95% C‎‎I: 0.‎154 to 0.556), p<0·001.

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This small study was conducted at the Imam Khomeini Hospital, Tehran more than six months ago and was only recently published.

It would be useful to know whether this treatment became more widely used and whether similar outcomes have continued to be seen.

Edalatifard M et al. Intravenous methylprednisolone pulse as a treatment for hospitalised severe COVID-19 patients: results from a randomised controlled clinical trial. European Respiratory Journal 2020; DOI: 10.1183/13993003.02808-2020. (1 January 2021).
https://erj.ersjournals.com/content/early/2020/09/09/13993003.02808-2020