Efficacy of corticosteroid in patients with COVID‐19: A multi‐center retrospective study and meta‐analysis

Abstract

Purpose To evaluate the efficacy of corticosteroids on COVID‐19 patients with different levels of disease severity. Methods In our multicenter study, 543 patients with confirmed COVID‐19 were classified as Non‐severe group and Severe group, and then were compared respectively for all‐cause mortality and length of hospital stay between those who received corticosteroids and not. By searching in PubMed, Web of Science, Embase and CNKI, we identified 13 retrospective studies and 6 random control trials eligible for criteria of inclusion, and conducted comprehensive meta‐analyses assessing the impacts of corticosteroids on mortality, length of stay, duration of RNA clearance and duration of fever. Results Our multicenter study demonstrated that low‐dose corticosteroids can reduce mortality in the multivariable Cox regression analysis for severe patients(p=0.03), while presented no influence in univariable analysis for non‐severe patients(p=0.14). From multivariable analyses, patients with corticosteroids in non‐severe group had longer duration of hospitalization(p=0.003), but did not in severe group(p=0.18). Moreover, for severe patients, corticosteroids can evidently shorten duration of fever. The same results were summarized in the meta‐analyses supplemented with the result that corticosteroids delayed viral clearing in non‐severe patients. Conclusion Corticosteroids should be considered based on patient's condition. For patients with non‐severe COVID‐19, corticosteroid was not recommended as a routine therapeutic initiative as that presented prolonged duration of hospitalization and delayed viral clearing, as well as no positive impact on prognosis. While low‐dose corticosteroids may benefit patients with severe COVID‐19 for it can manifestly lower risk of death and improve the clinical status to some extent. This article is protected by copyright. All rights reserved.

High-dose methylprednisolone versus dexamethasone therapy for hospitalized patients with severe COVID-19: a retrospective analysis

“…The duration of fever was similar between the two groups. Previous studies showed that corticosteroid therapy could shorten the duration of fever in patients with severe COVID-19 compared to standard therapy [10,22]. However, the present results suggest that the duration of fever and the type and dose of corticosteroid therapy might not be related.…”

“…The third factor was the severity of COVID-19. Several reports have supported corticosteroid use to treat patients with severe or critical COVID-19 and avoidance of corticosteroids for those with non-severe COVID-19 [9,11,21,22]. Although the optimal type of corticosteroids that would provide good clinical outcomes for patients with severe or critical COVID-19 are still unknown, methylprednisolone reportedly achieved higher lung tissue-to-plasma levels compared to dexamethasone in animal models [23].…”

Impact of Remdesivir on SARS-CoV-2 Clearance in a Real-Life Setting: A Matched-Cohort Study

“…Steroids were administered to more cases than controls. These drugs have been associated with potential delayed VC, 33 although this evidence has been questioned by different studies. 30 , 34 …”

505. Impact of Remdesivir on SARS-CoV-2 Clearance in a Real-Life Setting: A Matched-Cohort Study

“…Of these 490 patients, 54.7% achieved VC during hospitalization, while the remaining 45.3% reached VC during the post-discharge follow-up period. Median time to VC was 25 (16)(17)(18)(19)(20)(21)(22)(23)(24)(25)(26)(27)(28)(29)(30)(31)(32)(33)(34) days.…”