Background: COVID-19, caused by SARS-CoV-2, leads to severe respiratory complications, often requiring intensive care. Corticosteroids have been widely used to manage inflammation in COVID-19 patients, with dexamethasone and methylprednisolone being among the most commonly administered options. However, their relative efficacy remains a subject of debate. This study aimed to compare the effectiveness of dexamethasone and methylprednisolone in hospitalized COVID-19 patients.
Methods: This double-blind, randomized controlled trial was conducted at Imam-Ali Hospital, Karaj, Iran, on 300 hospitalized COVID-19 patients. Patients were randomly assigned to receive either intravenous dexamethasone (8 mg twice daily) or pulse methylprednisolone (500 mg daily for three days), in addition to standard COVID-19 management. The primary outcomes included mortality rate, ICU length of stay, and the need for mechanical ventilation. Secondary outcomes involved blood oxygen saturation (SpO₂) levels. Statistical analyses were performed using SPSS (version 26).
Results: The study included 150 patients in each treatment group. The mortality rate was 12.6% in the dexamethasone group and 15.3% in the methylprednisolone group, with no statistically significant difference (RR: 0.82, P = 0.50). The need for mechanical ventilation was observed in 16.6% of patients in the dexamethasone group and 21.3% in the methylprednisolone group, also without a significant difference (RR: 0.78, P = 0.30). However, ICU stay was significantly shorter in the dexamethasone group (9.5 days) compared to the methylprednisolone group (11.3 days) (P < 0.001). No significant differences were noted in SpO₂ levels between the two groups.
Conclusion: Both dexamethasone and methylprednisolone demonstrated similar efficacy in outcomes such as mortality rate need for mechanical ventilation in hospitalized COVID-19 patients. However, dexamethasone was associated with a significantly shorter ICU stay, suggesting a potential advantage in hospitalization duration. Further research is needed to refine corticosteroid use and explore additional immunomodulatory strategies to improve COVID-19 outcomes.
Keywords: COVID-19; Dexamethasone; Methylprednisolone pulse therapy; Respiratory distress syndrome.
© 2025. The Author(s).