Background: The most appropriate steroid dosage for moderate covid-19 pneumonia remained uncertain.

Aims: To compare the effectiveness of a pulse-methylprednisolone versus high-dose dexamethasone in hospitalized moderate COVID-19 pneumonia.

Methods: We enrolled patients aged > 18 years old who were admitted within 48 hours and diagnosed moderate COVID-19 pneumonia. The patients were randomized to receive 250 mg/day of methylprednisolone or 20 mg/day of dexamethasone over the first three days. Then the patients in both groups received the same dosage of dexamethasone in the next 7 days. On the fifth day of enrollment, the primary outcome was assessed by a 10-point WHO clinical progression scale. The secondary outcomes, including 90 days mortality, length of hospitalization, rate of ICU transfer, and complications, were recorded.

Results: Of 98 eligible patients,  fifty were randomized between October 2021 and October 2022. The mean age was 76 ± 13.3 years. The median date of illness at the time of randomization was 3 days (IQR 2, 5). Baseline characteristics did not differ between groups. The WHO clinical progression scales were similar between methylprednisolone and dexamethasone group at 5 and 10 days post-enrollment (4.84, 95% CI 4.35-5.33 vs. 4.76, 95% CI 4.27-5.25, p = 0.821 and 4.32, 95% CI 3.83-4.81 vs. 3.80, 95% CI 3.31-4.29, p = 0.140, respectively). Both groups did not differ in secondary outcomes.

Conclusion: Initial treatment with 250 mg/day of methylprednisolone for three days was not better than high-dose dexamethasone for moderate COVID-19 pneumonia.