Objective: This retrospective (matched paired) clinical trial aimed to compare the efficacy of dexamethasone
vs. methylprednisolone at equipotent (high) doses in patients with coronavirus disease 2019 (COVID-19)-
associated acute respiratory distress syndrome (ARDS).
Methods: A total of 347 patients with moderate and severe COVID-19-associated ARDS were administered
either a high (equipotent) dose of dexamethasone (32 mg) or methylprednisolone (180 mg) for a duration of
up to 10 days. All participants received the standard of care for critically ill COVID-19 patients.
Results: The primary outcomes included length of stay in the ICU, ICU mortality, and discharge from the
hospital. Based on the obtained results, a tendency towards more favorable clinical outcomes concerning the
length of stay in the ICU (in the group of patients treated with non-invasive mechanical ventilation (NIV),
p<0.05), ICU mortality, and discharge from the hospital (in the group of patients who were intubated,
p<0.05) in patients receiving the high dose of dexamethasone compared to those receiving
methylprednisolone was observed.
Conclusion: It appears that severe cases of COVID-19, especially intubated ones, treated with high doses of
dexamethasone have a more favorable clinical outcome than the use of equipotent doses of
methylprednisolone. However, larger multicenter studies are needed to validate our observations.
