Dexamethasone for treating SARS-CoV-2 infection: a systematic review and meta-analysis

Ferreto, Lirane Elize Defante; Bortoloti, Durcelina Schiavoni; Fortes, Paulo Cezar Nunes; Follador, Franciele Aní Caovilla; Arruda, Gisele; Ximenez, João Paulo Bianchi; Wendt, Guilherme Welter

doi:10.1590/1516-3180.2021.0120.r1.30062021

Cited by 8 publications

(6 citation statements)

References 20 publications

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“…A previous systematic review and meta-analysis indicated that glucocorticoids for severe infectious pneumonia are safe and effective (Stern et al 2017;Jiang et al 2019;Huang et al 2019). For COVID-19 pneumonia, the efficacy of glucocorticoids for hospitalized patients has been well investigated (Sarma et al 2020;RECOVERY Collaborative Group et al 2021;Ferreto et al 2021;Yu et al 2021), and they have been shown to reduce mortality and risk of progression to mechanical ventilation in patients with severe COVID-19 (Sarma et al 2020). However, there is little evidence on the efficacy and safety of glucocorticoids in outpatients with mild to moderate COVID-19.…”

Section: Discussionmentioning

confidence: 99%

Response to Glucocorticoid Therapy in Patients with Mild to Moderate Coronavirus Disease 2019 at a Japanese Care Facility

Kikuchi

Arita

Ono

et al. 2022

Tohoku J. Exp. Med.

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The fifth wave of the coronavirus disease 2019 (COVID-19) pandemic caused by delta variant infection depleted medical resources, and the Japanese government announced glucocorticoid use for outpatients. An appropriate outpatient-glucocorticoid treatment for COVID-19 has not been established; therefore, we created treatment manuals with indications for glucocorticoid administration in a care facility adequately equipped to manage patients with mild to moderate COVID-19. Thirty-eight patients (24 males, 14 females; mean age 40.5 ± 11.8 years) were treated with glucocorticoids from August 1 to October 1, 2021 [COVID-19 staging, mild (n = 1), moderate I (n = 19), and moderate II (n = 18)]. Patients were treated with 6.6 mg/day d.i.v. or 6 mg/day p.o. dexamethasone, or 20-30 mg/day p.o. prednisolone. The median (25 th -75 th percentile) number of days from the date of onset to glucocorticoid administration was 8.0 days (7.0-11.25 days). While 24 patients were hospitalized, the condition of 14 improved without hospitalization. The median number of days from glucocorticoid administration to hospitalization was 1.0 day (range, 1.0-1.0 day). In the non-hospitalized patients, the median number of days of glucocorticoid administration was 5.0 days (5.0-5.25 days). The mean number of days from glucocorticoid administration to discharge from the care facility for non-hospitalized patients was 8.4 ± 3.3 days. The adverse reactions among non-hospitalized patients included insomnia (n = 1) and mild liver dysfunction (n = 3). The present method of glucocorticoid administration can be safely used for patients with COVID-19 in care facilities.

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Section: Discussionmentioning

confidence: 99%

Response to Glucocorticoid Therapy in Patients with Mild to Moderate Coronavirus Disease 2019 at a Japanese Care Facility

Kikuchi

Arita

Ono

et al. 2022

Tohoku J. Exp. Med.

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“…The tool is suitable for reviews including randomised and non-randomised studies. It includes 16 domains (7 considered critical) relating to the research question, review design, search strategy, study selection, data extraction, justification for excluded stud- Lee, 2020 [13] Li, 2020 [14] Yang, 2020 [15] Cantini, 2020 [16] Cheng, 2020 [17] Wang, 2020 [18] Sarma, 2020 [19] Tlayjeh, 2020 [20] WHO REACT Working Group, 2020 [21] Ye, 2020 [22] Van Paassen, 2020 [23] Chaudhuri, 2021 [24] Hasan, 2021 [25] Ma, 2021 [26] Pasin, 2021 [27] Pulakurthi, 2021 [28] Sahu, 2021 [29] Tu, 2021 [30] Cano, 2021 [31] Moosazadeh, 2021 [32] Nguyen, 2021 [33] Ferreto, 2021 [34] Yu, 2021 [35] Sahilu, 2021 [36] Boppana, 2021 [37] Wagner, 2021 [38] ies, description of included studies, risk of bias, sources of funding, meta-analysis, heterogeneity, publication bias, and conflicts of interest (see Table 2 for details of each question). Two review authors (MC, IP) independently assessed the quality of evidence in the included reviews and the methodological quality of the SRs.…”

Section: Assessment Of Methodological Quality Of Systematic Reviewsmentioning

confidence: 99%

Untitled

2022

infez med

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A reappraisal of the validity of the conclusions of systematic reviews (SRs) and meta-analyses related to corticosteroids use for the treatment of COVID-19. Material and Methods: An overview of SRs (umbrella review). The methodological quality of the SRs was assessed using tha AMSTAR-2 checklist; quality of the evidence was appraised following the GRADE approach. Results: 35 SRs were included in this overview. Data were from 307 overlapping reports, based on 121 individual primary studies (25 randomized clinical trials (RCTs), 96 non-RCTs. In critically ill patients the use of steroids significantly reduced mortality compared to standard of care in 80% of the SRs, more often with moderate/high level of certainty; however, in patients not requiring oxygen supplementation the use of steroids increased the overall mortality in 2/3 of the comparisons. Clinical progression of diseases (need for me-chanical ventilation, or for intensive care admission) was more commonly observed among controls compared to steroids recipients (in 9 out of 14 comparisons; certainty of evidence from very-low to moderate). The occurrence of adverse events was similar among steroids recipients and controls. Other outcomes (i.e., viral clearance, length of hospital stay) or issue related to optimal dose and type of steroids were addressed in a minority of SRs, with a high level of uncertainty, so that no definitive conclusions can be drawn. Conclusions: There is moderate certainty of evidence that corticosteroids reduce mortality and progression of disease in critically ill COVID-19 patients compared to standard of care, without increasing the occurrence of adverse events.

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“…Other medications, such as hydroxychloroquine 129 and lopinavir/ritonavir, 130 have demonstrated limited effectiveness in reducing viral load or improving patient outcomes. Additionally, the use of corticosteroids, particularly dexamethasone, 131 has shown benefits in reducing mortality rates and alleviating severe respiratory symptoms. Furthermore, monoclonal antibody therapies, such as casirivimab and imdevimab, 132 have been shown to reduce viral load and the risk of hospitalization in high‐risk patients.…”

Section: Viral Load In Clinical Patient Management and In Clinical Re...mentioning

confidence: 99%

Viral load: We need a new look at an old problem?

Guterres

2023

Journal of Medical Virology

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The concept of viral load was introduced in the 1980s to measure the amount of viral genetic material in a person's blood, primarily for human immunodeficiency virus (HIV). It has since become crucial for monitoring HIV infection progression and assessing the efficacy of antiretroviral therapy. However, during the coronavirus disease 2019 pandemic, the term “viral load” became widely popularized, not only for the scientific community but for the general population. Viral load plays a critical role in both clinical patient management and research, providing valuable insights for antiviral treatment strategies, vaccination efforts, and epidemiological control measures. As measuring viral load is so important, why don't researchers discuss the best way to do it? Is it simply acceptable to use raw Ct values? Relying solely on Ct values for viral load estimation can be problematic due to several reasons. First, Ct values can vary between different quantitative polymerase chain reaction assays, platforms, and laboratories, making it difficult to compare data across studies. Second, Ct values do not directly measure the quantity of viral particles in a sample and they can be influenced by various factors such as initial viral load, sample quality, and assay sensitivity. Moreover, variations in viral RNA extraction and reverse‐transcription steps can further impact the accuracy of viral load estimation, emphasizing the need for careful interpretation of Ct values in viral load assessment. Interestingly, we did not observe scientific articles addressing different strategies to quantify viral load. The absence of standardized and validated methods impedes the implementation of viral load monitoring in clinical management. The variability in cell quantities within samples and the variation in viral particle numbers within infected cells further challenge accurate viral load measurement and interpretation. To advance the field and improve patient outcomes, there is an urgent need for the development and validation of tailored, standardized methods for precise viral load quantification.

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Dexamethasone for treating SARS-CoV-2 infection: a systematic review and meta-analysis

Cited by 8 publications

References 20 publications

Response to Glucocorticoid Therapy in Patients with Mild to Moderate Coronavirus Disease 2019 at a Japanese Care Facility

Response to Glucocorticoid Therapy in Patients with Mild to Moderate Coronavirus Disease 2019 at a Japanese Care Facility

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Viral load: We need a new look at an old problem?

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