The preliminary report from the randomized RECOVERY clinical trial (NEJM JW Infect Dis Sep 2020 and N Engl J Med 2020 Jul 17; demonstrated that 10 days of dexamethasone resulted in a mortality benefit in hospitalized COVID-19 patients, especially those on mechanical ventilation. Investigators at a referral center in Brazil have now performed a double-blind, randomized, placebo-controlled clinical trial evaluating the efficacy of a 5-day course of methylprednisolone (MP) at reducing the mortality of patients hospitalized with COVID-19.

Of 416 patients randomized, 393 (mean age, 55 years) completed follow-up: 194 in the MP arm and 199 in the placebo arm. No patient received remdesivir, anti-IL-6, or anti-IL-1 agents. The most common comorbidities were diabetes, hypertension, and alcohol use disorder. One third of patients were mechanically ventilated. Mortality at day 28 was 37.1% in the MP group and 38.2% in the placebo group. No between-group differences were apparent in mortality at 7 days or 14 days, viral clearance in the upper airways, or need for mechanical ventilation at 7 days. In a subgroup analysis, day-28 mortality was significantly lower with MP versus placebo among patients older than 60 years of age (46.6% vs. 61.9%).

What is your thought on this ongoing debate? should we use it or not?