Table 1.
Trials using methylprednisolone (MP); by design (R = randomized in blue and Rs = retrospective and obs = observational in yellow), timing, duration, outcomes (focusing on mortality data), and viral shedding.
| Trial Name/Authors (Reference) | Steroid Used, Dosing | Trial Design, Population | Initiation Timing (Days) | Duration of Administration (Days) | Main Outcome(s) | Secondary Outcome(s) | Viral Clearance |
|---|---|---|---|---|---|---|---|
| Jeronimo CMP et al. MetCOVID [30] | MP 0.5 mg/kg × 2 vs. placebo | MC/R/DB phase II-b placebo-controlled | 5 | No difference in D28 mortality MP pts > 60 yo had lower D28 mortality | No difference in: D7, D14 mortality/D7 intubation and PFR < 100/LOHS/Radiological presence of fibrosis/BOOP after D7 | No difference on D7viral clearance | |
| Corral-Gudino L et al. GLUCOCOVID trial [13] | MP 40 mg bid × 3 d, then 20 mg bid × 3 d | MC/O-L/R pts on O2 SOC vs. SOC + MP | NA | 6 | Composite endpoint: death, ICU admission, need for NIV MP: no significant effect on endpoint (ITT analysis) MP: beneficial effect (PP analysis) | NA | NA |
| Tang X et al. [42] | MP 1 mg/kg/d vs. no MP | Ps/MC/R Single-blind ward pts | 8 (6–16) since Sx onset | 7 | MP vs. no MP: no difference in incidence of clinical deterioration (4.8 vs. 4.8%; OR 1.000 [95% CI, 0.134–7.442]; p = 1.000) | MP vs. no MP: no difference in: D14 clinical cure rate/time to clinical cure/ICU admission/hospitalization duration/in-hospital mortality (all p > 0.05) | MP significantly prolonged SARS-CoV-2 shedding (median, 11 d vs. 8d; HR 1.782 (1.057–3.003); p = 0.030) |
| Gong Y et al. [21] | MP 1 to 2 mg/kg/d halved every 3 d vs. no MP | Rs | 5–10 | No difference in radiologic progression within 20 d | Longer time to negative PCR in MP group (p = 0.03) | ||
| Wang et al. [35] | MP 1 to 2 mg/kg/d | Obs severe COVID-19 pts | 5–7 | MP: faster SpO2 improvement, less likely to receive MV (p = 0.05), faster ↓ CRP, IL-6 No significant difference in: mortality, ↓ LOHS and ICU LOS | |||
| Papamanoli A et al. [43] | MP median 160 mg (120–180)/d | SC/Rs cohort HFNC > 50%, MP vs. no CS | 10 since Sx onset, 2 since admission, 1 since HFNC initiation | Median: 10 incl tapering | MP: 37% lower risk of death D28 (p = 0.003) and less frequent MV (p = 0.001) | No difference in mortality between groups | |
| Fernandez-Cruz et al. [32] | MP 1 mg/kg/d or pulse | SC/Rs MP vs. no MP | 10 since Sx onset | NA | MP Mortality 13.9% vs. 23.9% no MP (HR = 0.51 95% CI, 0.27–0.96, p = 0.044). Dosing scheme not associated with mortality. | Mortality in moderate-severe ARDS: MP 26.2% vs. 60% no CS, OR = 0.23 (95% CI, 0.08–1.71) | |
| Zha L et al. [44] | MP 40–80 mg/day | Obs/MC CS vs. no CS | within 24 h after admission | 5 | LOHS and Duration of Sx: not associated with CS | CS: no influence on viral clearance | |
| Li Y et al. [45], Shangai cohort | MP 0.75–1 mg/kg/d × 3 d, then 20 mg MP × 3 d vs. (no MP and rescue CS) | MC/Obs/ | Early (according to LDH and radiographic progression) | ≤7 | ↓ MV need in early MP (p = 0.037) | No difference in viral clearance time | |
| Ma Q et al. [38] | MP 40–80 mg/d vs. no CS | MC/Rs cohort severe and critically ill pts | No difference: Mortality, LOHS CS group: ↓ Sx duration |
No difference in viral clearance time | |||
| Salton F et al. [22] | MP 80 mg loading dose, then 80 mg/day cont infusion | MC/Obs severe COVID-19 MP vs. no MP | Min 8 | Composite endpoint:ICU referral/ intubation need/ D28 death: significantly ↓ compared with the control group: aHR, 0.41 | MV free d ΔCRP | Not affected | |
| Yuan M et al. [46] | MP max dose 52.5 mg | Rs nonsevere pts MP vs. no MP | Median 8.3 since Sx onset | Median duration 10.8 | Nonsevere pts on CS:progressed to severe disease, had ↑ LOHS and ↓c duration of fever (not statistically significant difference vs. non-CS pts) | Nonsevere pts on CS: ↑ duration of viral shedding, (not statistically significant difference) | |
| Wu C et al. [31] | MP vs. no MP | Rs/Obs | NA | NA | MP in ARDS pts: ↓ risk of death (HR, 0.38; 95% CI, 0.20–0.72, p = 0.003) | NA |