Methylprednisolone may be better than dexamethasone for hospitalized COVID-19 patients
Dexamethasone has been shown to be effective in treatment of hypoxemic patients with COVID-19. However, it may not be the most appropriate corticosteroid for these patients. Researchers at the Shiraz University of Medical Sciences (Iran) conducted a prospective triple-blinded randomized controlled trial to assess the effectiveness of methylprednisolone treatment versus dexamethasone for hospitalized COVID-19 patients.
They enrolled 86 hospitalized COVID-19 patients from August to November 2020, and randomly assigned them into two groups to receive either methylprednisolone (2 mg/kg/day; intervention group) or dexamethasone (6 mg/day; control group). Results were assessed based on a 9-point WHO ordinal scale extending from uninfected (point 0) to hospitalized with severe disease (point 5) to death (point 8).
The results of the study, published on April 12, 2021, in BMC Infectious Diseases, showed that there were no significant differences between the groups on admission. However, the methylprednisolone group showed significantly better clinical status compared to the dexamethasone group at both day 5 and day 10.
The mean length of hospital stay was shorter in the methylprednisolone group and the need for a ventilator was also significantly lower in the methylprednisolone group than in the dexamethasone group (18.2% vs 38.1%, respectively).
The authors conclude that better penetration of methylprednisolone in the lungs may have led to the observed improved outcomes. The differences found may also be explained by the relatively higher dose of corticosteroid, given that the estimated 6 mg of dexamethasone a day is equivalent to approximately 32 mg of methylprednisolone, resulting in a more potent dose for the methylprednisolone group.
Liver injury from acetominophen at low doses linked to fasting, heavy drinking
Acetaminophen is commonly used to treat minor aches and pains; however, patients have been cautioned about liver injury associated with overuse. Because of the extensive use of this medication, Louvet and colleagues at Hôpital Huriez and the Université de Lille (France) performed an evaluation of acute liver injury (ALI) associated with therapeutic doses (less than 6 g/d) of acetaminophen versus overdose levels.
The study, published in the May 2021 issue of Hepatology, included all patients admitted to Hôpital Huriez (Lille, France) with severe acetominophen-related ALI from 2002 to 2019, either attributable to therapeutic doses (89 patients) or overdose (311 patients).
Factors associated with ALI with therapeutic doses were fasting for one day or more (47.5% of patients taking therapeutic doses vs. 26% taking overdose levels of acetaminophen), excess drinking (93.3% vs. 48.5%), and repeated acetominophen use (4 vs. 1 day). Patients with ALI associated with therapeutic doses were older than those with overdose levels (44 vs. 30.7 years) and had more severe liver injury.
In the overall population, independent predictors of disease severity were older age, longer duration of acetaminophen use, and excess drinking. Thirty-day survival was lower in patients who had been given a therapeutic dose than in overdose (87.2% vs. 94.6%).
The authors concluded that ALI with therapeutic doses of acetominophen is associated with more severe liver injury than overdose levels, and only occurs in patients who experience excess drinking and/or fasting. They suggest that a warning should be issued about the repeated use of nontoxic doses of acetominophen in patients with those risk factors.