Steroids use in non-oxygen requiring COVID-19 patients: a systematic review and meta-analysis

Abstract

Background Corticosteroids have become the mainstay treatment in severe COVID-19. However its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis was conducted to assess effect of steroids in mild COVID-19 patients. Methods PubMed, EMBASE, Web of Science and Medrxiv were searched from December-31, 2019 to May-14, 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay. Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane’s ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method. Results 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (involving 2214 non–oxygen requiring COVID 19 patients) were included and analysed. Overall odds of progression to severe disease among the non-oxygen requiring COVID-19 patients receiving steroids was 5.97 (95%CI: 1.27–27.99, I 2 - 0%) and odds of death (OR: 1.35, 95%CI: 1.01–1.79; I 2–0%) as compared to the patients not receiving steroids. Mean duration of fever (7.4 days), duration to viral clearance (18.9 days), and length of hospital stay (20.8 days) were significantly higher in the steroid arm, as compared to that in no-steroid arm (6.7 days, 16.5 days, 15.2 days respectively). Conclusion Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial. Protocol registration The study was prospectively registered in PROSPERO (CRD 42021254951).

Standard of care for COVID-19 in randomized clinical trials registered in trial registries and published in preprint servers and scholarly journals: a cross-sectional study

“…It is possible that the decision to use corticosteroids as a part of SoC was determined by the severity of COVID-19. However, corticosteroids have also been tested in non-oxygen requiring COVID-19 patients since the emergence of SARS-SoV-2, with the results now showing that they can be more detrimental than beneficial [27]. A Cochrane review found some benefits of corticosteroids in hospitalized patients [28].…”

Do Corticosteroids Reduce Mortality or Progression to Severe Disease for Non-Oxygen Requiring Patients Infected With COVID-19?

“… 6 , 7 , 12 Furthermore, this review suggests that systemic corticosteroids are harmful in this nonhypoxemic cohort of COVID-19 patients, associated with higher mortality and progression to severe disease. 14 Although uncommon with COVID-19, 15 the authors suggest that corticosteroids may increase the risk of secondary bacterial infections.…”

“…Nevertheless, the a priori choice of mortality as an end point in these less critically ill patients with COVID-19 infections is less logical than in sicker cohorts. 13 , 28 …”

Response to: Corticosteroids for mild COVID-19 treatment: opening the floodgates of therapeutic benefits

“…As of now, no clinical trial has shown any benefit of using corticosteroids in mild COVID-19, with a recently conducted meta-analysis suggesting possible harm. 5 Interestingly, our commentary 1 alluded to the practice of using systemic steroids (oral or parenteral) as an extrapolation to their use in severe COVID-19, which did not have and still has no scientific basis besides being potentially harmful. 6 , 7 While use of systemic steroids, for the said indication, cannot be justified in the wake of available evidence, we feel that the jury is still out on the role of inhaled steroids in mild COVID-19 and would require further trials before a definitive verdict.…”