Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis

Abstract

Background To systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients. Methods We searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach. Results Out of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69–1.22, I 2 = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23−0.73, I 2 = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11–1.93, I 2 = 43.38%). Conclusion In this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients’ population that could benefit from CST.

Comparison of Associations Between Glucocorticoids Treatment and Mortality in COVID-19 Patients and SARS Patients: A Systematic Review and Meta-Analysis

“…As of writing this manuscript (early November 2020), 16 meta-analyses 3,[104][105][106][107][108][109][110][111][112][113][114][115][116][117][118] have examined the use of glucocorticoids in patients with COVID-19 or coronavirus infections. Regarding mortality, 4 metaanalyses 3,106,111,112,117 included RCTs (1 including 7 RCTs, 3 including 1 or 2 RCTs) and the rest only included observational studies.…”

“…As of writing this manuscript (early November 2020), 16 meta-analyses 3,[104][105][106][107][108][109][110][111][112][113][114][115][116][117][118] have examined the use of glucocorticoids in patients with COVID-19 or coronavirus infections. Regarding mortality, 4 metaanalyses 3,106,111,112,117 included RCTs (1 including 7 RCTs, 3 including 1 or 2 RCTs) and the rest only included observational studies. Of these meta-analyses, 5 3,[104][105][106][107] found that glucocorticoids treatment decreased all-cause mortality, 7 [108][109][110][111][112][113][114] found no association between glucocorticoids treatment and allcause mortality, and the others [115][116][117][118] found glucocorticoids treatment increased all-cause mortality.…”

“…Regarding mortality, 4 metaanalyses 3,106,111,112,117 included RCTs (1 including 7 RCTs, 3 including 1 or 2 RCTs) and the rest only included observational studies. Of these meta-analyses, 5 3,[104][105][106][107] found that glucocorticoids treatment decreased all-cause mortality, 7 [108][109][110][111][112][113][114] found no association between glucocorticoids treatment and allcause mortality, and the others [115][116][117][118] found glucocorticoids treatment increased all-cause mortality. In general, meta-analyses that supported glucocorticoids treatment mostly identi ed studies on COVID-19 patients who were severely-ill or with ARDS.…”

Corticosteroids for COVID-19

“…Table 3 summarizes the characteristics and main finding from 13 systematic reviews and meta-analyses published since March 2020 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 . Two of these systematic reviews included only randomized controlled trials 76 , 77 .…”

<p>An Up-to-Date Overview of Therapeutic Agents for the Treatment of COVID-19 Disease</p>

“…This systematic review showed that Corticosteroid treatment was not associated with reduced short-term mortality but possibly with delayed viral clearance. 77 A systematic review and meta-analysis conducted by Yang Z et al on a total of 5270 patients from 15 studies showed that critical patients were more likely to require corticosteroid treatment but associated with higher mortality, a longer length of stay, and a higher rate of bacterial infection. 78 A recent prospective meta-analysis of 7 randomized trials conducted by Horby P et al included 1703 critically ill COVID-19 patients.…”