Effectiveness and Safety of Glucocorticoids to Treat COVID-19: A Rapid Review and Meta-Analysis

Abstract

Background: Glucocorticoids are widely used in the treatment of various pulmonary inflammatory diseases, but they are also often accompanied by significant adverse reactions. Published guidelines point out that low dose and short duration systemic glucocorticoid therapy may be considered for patients with rapidly progressing COVID-19 while the evidence is still limited. Methods:We comprehensively searched electronic databases and supplemented the screening by conducting a manual search. We included RCTs and cohort studies evaluating the effectiveness and safety of glucocorticoids in children and adults with COVID-19, SARS and MERS, and conducted meta-analyses of the main indicators that were identified in the studies. Results:Our search retrieved 23 studies, including one RCT and 22 cohort studies, with a total of 13,815 patients. In adults with COVID-19, the use of systemic glucocorticoid did not reduce mortality (RR=2.00, 95% CI: 0.69 to 5.75, I²=90.9%) or the duration of lung inflammation (WMD=-1 days, 95% CI: -2.91 to 0.91), while a significant reduction was found in the duration of fever (WMD=-3.23 days, 95% CI: -3.56 to -2.90). In patients with SARS, glucocorticoids also did not reduce the mortality (RR=1.52, 95% CI: 0.89 to 2.60, I²=84.6%), duration of fever (WMD=0.82 days, 95% CI: -2.88 to 4.52, I²=97.9%) or duration of lung inflammation absorption All rights reserved. No reuse allowed without permission.(which was not certified by peer review) is the author/funder, who has granted medRxiv a license to display the preprint in perpetuity.

Comparing outcomes of hospitalized patients with moderate and severe COVID-19 following treatment with hydroxychloroquine plus atazanavir/ritonavir

“…However, the use of corticosteroid may non-significantly increase the risk of mortality [25]. Moreover, without reduction in mortality rate, these medications can increase duration of hospital stay [26]. The effects on mortality and outcomes can be generalized to IVIG and vitamin C in our study.…”

Are the steroids a blanket solution for COVID‐19? A systematic review and meta‐analysis

“…Similar systematic review and meta‐analysis on severe acute respiratory syndrome (SARS) and the Middle East respiratory syndrome and COVID‐19 reported that systemic glucocorticoid is not beneficial for reducing the mortality (RR = 2.00, 95% CI: 0.69–5.75, I 2 = 90.9%) and the duration of lung inflammation (WMD = −1 days, 95% CI: −2.91 to 0.91) 31 …”

“…Similarly, a recent meta‐analysis have reported glucocorticoid has no role in shortening the duration of fever either in patients with severe SARS (WMD = −1.1 day, 95% CI: −4.9 to 2.7, I 2 = 58.3%) or in patients with mild SARS (WMD = 0.5 days, 95% CI: −4.2 to 5.1, I 2 = 95.1%) 31 …”

Pathogenesis‐directed therapy of 2019 novel coronavirus disease

“…A third study 242 that used the second week pulsing of low‐dose methylprednisolone noted that this was effective in improving the prognosis of patients with severe COVID‐19 pneumonia. Several reviews 243,244 of the use of corticosteroids in COVID‐19 found that in adults with COVID‐19, the use of systemic glucocorticoids did not reduce mortality and prolonged the duration of hospitalization. Two factors are likely to have influenced these seemingly conflicting results.…”

“…However, the use of antiviral agents will depend on the targeted mechanism 22 and should be done early in the COVID‐19 infection before the host hyperinflammatory reaction occurs 214 . Reviews of antiviral options and the theoretical reasons for their use in the therapy of COVID‐19 have been published 241–245 . In the following sections, only those antiviral agents that have demonstrated reasonable efficacy in COVID‐19 patients will be reviewed in detail.…”