Pulse Dose Methylprednisolone Therapy in a Cohort of Very Severe COVID-19 Patients in a Resource-limited Setting in Myanmar: A Case Series of 13 Patients

Aims: Coronavirus disease 2019 (COVID-19) has very high mortality in severe forms of disease, where immunopathology plays an important role. Use of immunomodulating therapies including 6 to 12 mg of dexamethasone is well established. Higher doses of corticosteroids were used with reported success in some settings. This study aims to explore the role of pulse dose methylprednisolone therapy in very severe COVID-19 patients in preventing the need for ICU care and death in resource-limited setting.

Study Design: Retrospective case series study.

Place and Duration of Study: Oak-ta-chat-thal-ta-pwint COVID-19 treatment center in Yangon, Myanmar between September 2021 to December 2021.

Methodology: This study included 13 confirmed COVID-19 patients with severe to critical illness, who were treated with pulse dose methylprednisolone therapy. We reviewed the patients’ demographics, comorbidities, and disease severity before starting pulse dose methylprednisolone therapy and changes in oxygen requirement, chest X-ray scores, inflammatory markers, development of significant clinical events, and 28 days mortality after therapy.

Results: Before pulse dose methylprednisolone therapy, all 13 patients had very severe disease (mean SPO2/FiO2 = 173 mmHg, mean SPO2 = 88.54%, mean CRP = 115 mg/L, mean ferritin = 1,295.5 ng/mL and mean Brixia Score = 6.54). They received 3-7 days (mean = 5.5 days) of pulse dose methylprednisolone. Ten patients (76%) survived in a setting with limited ICU care. High ferritin was a significant predictor of mortality. Improvement in oxygen requirement was noticeable after 1-11 days (mean = 5.6 days). Hyperglycemia was common and confirmed bacterial infection was found in 3 patients, but all patients received empirical antibiotics therapy.

Conclusion: Pulse-dose methylprednisolone therapy may be an effective salvage therapy in a carefully selected subset of very severe COVID-19 patients. It might be a feasible alternative to other more expensive immunomodulating agents and organ support treatments in a resource-limited setting.