Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes

Abstract

Background Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored including corticosteroids (CS); preliminary results of CS in coronavirus disease 2019 (COVID-19) are encouraging, however, the role of CS is still controversial. Research Question What is the impact of CS in mortality, ICU admission, mechanical ventilation and viral shedding in COVID-19 cases? Study Design and Methods We conducted a systematic review of literature on CS and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature until July 22, 2020, that report outcomes of interest in COVID-19 patients receiving CS with a comparative group. Results A total of 73 studies with 21,350 COVID-19 cases were identified. CS use was widely reported in mechanically ventilated (35.3%), ICU (51.3%) and severe COVID-19 cases (40%). CS showed mortality benefit in severelly ill COVID-19 cases (OR 0.65, 95%CI 0.51-0.83, P=0.0006), however, no beneficial or harmful effects were noted amongst high- or low-dose CS regimens. Emerging evidence shows that low-dose CS do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high- and low-dose CS regimens. Interpretation Our results show evidence of mortality benefit in severely-ill COVID-19 treated with CS. CS are widely used in COVID-19 cases worldwide and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for CS.

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“…On the other hand, the use of dexamethasone has been shown to lower the mortality rate in hospitalized COVID-19 patients receiving supplemental oxygen [ 51 ]. Although corticosteroids’ effects on mortality are well known based on the current data, their effects on time to recovery need further studies and the current results show no significant association [ 52 ].…”

Evaluation of the safety and efficacy of using human menstrual blood‐derived mesenchymal stromal cells in treating severe and critically ill COVID‐19 patients: An exploratory clinical trial

“…Studies have shown that compared with patients with mild to moderate disease, patients with severe SARS‐CoV‐2 have higher levels of proinflammatory cytokines in serum samples 82 . A meta‐analysis indicated that the mortality rate was reduced in severe COVID‐19 patients treated with corticosteroids 83 . More recently, the recovery collaborative group reported that dexamethasone (a type of corticosteroid) significantly decreased 28‐day mortality in patients hospitalized with COVID‐19 22 .…”

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“…; therefore, shared decision making between the clinician and patient is recommended (guidance 2.2, 2.4, and 2.5). Chronic systemic corticosteroids should be avoided, if possible, for the management of PsA, because additional research confirms that their use is associated with worse COVID-19 outcomes (guidance 2.3) 15,29.…”