Background: Up till now, there has been no definite treatment for severe acute respiratory syndrome coronavirus-2 (SARS-COV-2). Some studies have shown favorable effects of corticosteroids on COVID-19. This study aimed to compare the effect of dexamethasone versus methylprednisolone in COVID-19 patients, and their effects upon the neutrophil/lymphocyte ratio (NLR) in correlation to mortality.

Methods: A randomized double-blind clinical trial of 60 patients was divided into two equal groups. Group D, was delivered intravenous dexamethasone 8 mg/day for 7 days. Group M, was delivered intravenous methylprednisolone 1 mg/kg/day in 2 divided doses per day for 7 days. Inflammatory response monitoring by NLR and other markers was compared between the two groups.

Results: The NLR was significantly lower in the methylprednisolone group than the dexamethasone group on the 5th and 7th days (p-values of 0.014 and 0.019 respectively). The IL-6 was also significantly lower in the M than the D group on the 7th day (16.70 ± 5.5 versus 39.61 ± 8.19 with p-value 0.024). The mortality rate was significantly lower in the methylprednisolone group than dexamethasone group as well (5 versus 13 patients respectively with p-value = 0.024). The ROC curve for the NLR and its correlation to the mortality rate showed a higher area under the ROC curve in group M than in group D (0.968 versus 0.81 respectively). The optimal cut-off points were 13.25 in group D versus 10.65 in group M.

Conclusions: Methylprednisolone can reduce inflammatory response and mortality as reflected upon NLR and IL-6 than dexamethasone in COVID-19 patients admitted to ICU. Clinical Trials Registration Number: NCT04909918: All authors stated that the manuscript has been read and approved by all of them and that each author believes that the manuscript represents an honest work