Metylprednisolons effekt hos COVID-19-patienter : Om MP kan minska risken för dödlighet hos COVID -19 patienter.

Sammanfattning: Background: Severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) is the seventh member of the coronavirus family distinct from MERS-CoV (Middle East respiratory syndrome). At the end of December 2019, the virus first emerged in Wuhan, China, The disease which   was named the coronavirus disease (COVID-19) by the World Health Organization. The disease has led to considerable healthcare burden, mortality and affected the world economy. The combination of cytokine release syndrome, acute respiratory distress syndrome (ARDS) and multiorgan failure can result in high mortality in COVID-19 patients. The inflammatory process and viral activity can cause pneumonia and eventually cause ARDS, which is a serious inflammatory condition. Glucocorticoids may help with COVID-19 due to their anti-inflammatory effects. Methylprednisolone (MP) and dexamethasone are  glucocorticoids suggested to reduce mortality in COVID-19 patients. Tocilizumab is a humanized monoclonal antibody against the IL-6 receptor. It acts as an immunosuppressant and interleukin inhibitor.  Aim: The study was performed to investigate whether methylprednisolone can reduce the risk of mortality in COVID -19 patients.  Material & Metod: Relevant scientific clinical randomized trials were searched using the Pubmed medical database and the searches were performed with the search term "Methylprednisolone AND COVID -19" with the article type filter "Randomized Controlled Trial". The studies that were selected were between 2020- 2022. The search gave 14 articles and 4 articles were selected.  Results: The effect of methylprednisolone to reduce the risk of mortality in COVID -19 patients was investigated in the four clinical studies and the results showed a reduction in mortality at day 45 in patients treated with MP alone compared to the control group and MP plus tocilizumab. Study II also showed reduced mortality indicated in the per protocol analysis with a risk reduction of 0.42. In study III investigating the effect of 250 mg MP versus 6 mg dexamethasone, no statistically significant reduction in mortality was shown. In contrast, in study IV, less mortality (18.6%) was reported in the MP group compared to the control group receiving dexamethasone (37.5%), but the difference was not statistically significant (p=0.076). Discussion: The selected articles reported varying results regarding the effect of methylprednisolone on mortality. The majority showed that methylprednisolone can reduce the risk of mortality in COVID-19 patients, in addition, however, further clinical studies with a larger study population and a longer treatment course are needed.