Archives of Academic Emergency Medicine

Vol. 14 No. 1 (2026)

Comparative 28-day Outcomes of Pulse-Dose Methylprednisolone versus Prolonged Low-Dose Dexamethasone in Hospitalized COVID-19 Pneumonia: A Cohort Study

Archives of Academic Emergency Medicine, Vol. 14 No. 1 (2026), 1 October 2025 , Page e53
https://doi.org/10.22037/aaem.v14i1.3063

Abstract

Introduction: Corticosteroids are widely used in COVID-19 pneumonia; however, the optimal regimen remains uncertain. We compared clinical outcomes between pulse-dose methylprednisolone and prolonged low-dose dexamethasone in hospitalized patients with COVID-19 pneumonia. Methods: In this retrospective cohort study, adult patients hospitalized with COVID-19 pneumonia (18 April–30 August 2021), who received either pulse-dose methylprednisolone or prolonged low-dose dexamethasone, were compared regarding 28-day mortality, in-hospital mortality, and treatment-free days. Multivariable Cox regression and propensity score matching (PSM) were used to adjust for confounding. Results: Among 460 patients (269 pulse-dose methylprednisolone, 191 prolonged low-dose dexamethasone), no significant difference in 28-day mortality was observed in multivariable analysis (aHR: 1.51; 95% CI: 0.74–3.09, p = 0.26). After PSM, 28-day mortality remained similar (HR: 1.40; 95% CI: 0.64–3.06; p = 0.38), although a trend toward higher in-hospital mortality was noted with pulse-dose methylprednisolone (HR: 2.07; 95% CI: 0.96–4.42; p = 0.06). Conclusion: Pulse-dose methylprednisolone was not associated with a significant difference in 28-day mortality compared with prolonged low-dose dexamethasone. A trend toward higher in-hospital mortality was observed with pulse-dose methylprednisolone, warranting cautious interpretation due to potential residual confounding.

Keywords:
  • Methylprednisolone
  • Dexamethasone
  • COVID-19
  • SARS-Cov-2
  • Pneumonia
  • Viral

How to Cite

1.
Sanguanwit P, Rinprasertmeechai P, Leela-amornsin S. Comparative 28-day Outcomes of Pulse-Dose Methylprednisolone versus Prolonged Low-Dose Dexamethasone in Hospitalized COVID-19 Pneumonia: A Cohort Study. Arch Acad Emerg Med [Internet]. 2026 Sep. 13 [cited 2026 Sep. 28];14(1):e53. Available from: https://journals.sbmu.ac.ir/aaem/index.php/AAEM/article/view/3063

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