Systemic corticosteroids for the treatment of COVID-19

Wagner, Carina; Griesel, Mirko; Mikołajewska, Agata; Mueller, Anika; Nothacker, Monika; Kley, K; Metzendorf, Maria‐Inti; Fischer, Anna-Lena; Kopp, Marco; Stegemann, Miriam; Skoetz, Nicole; Fichtner, Falk

doi:10.1002/14651858.cd014963

Cited by 162 publications

(154 citation statements)

References 74 publications

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“…In total, 94.3% of CAM patients received steroid therapy, thus indicating the clinical severity of their COVID-19 infection. In a recent Cochrane review, Wagner et al 2021 concluded with moderate certainty that systemic corticosteroids could probably reduce all-cause mortality in symptomatic COVID-19 patients [73]. As of 4 August 2021, the National Institutes of Health (NIH) recommend the use of corticosteroids to control the systemic inflammatory responses that lead to lung injury and multiorgan dysfunction in severely ill COVID-19 patients, and this recommendation was packed with a metaanalysis suggesting that corticosteroids can reduce all-cause mortality and the duration of mechanical ventilation [74,75].…”

Section: Discussionmentioning

confidence: 99%

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Hussain

Riad

Singh

et al. 2021

JoF

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Mucormycosis, a secondary fungal infection, gained much attention in the ongoing COVID-19 pandemic. This deadly infection has a high all-cause mortality rate and imposes a significant economic, epidemiological, and humanistic burden on the patients and healthcare system. Evidence from the published epidemiological studies showed the varying prevalence of COVID-19-associated mucormycosis (CAM). This study aims to compute the pooled prevalence of CAM and other associated clinical outcomes. MEDLINE, Embase, Cochrane COVID-19 Study Register, and WHO COVID-19 databases were scanned to retrieve the relevant articles until August 2021. All studies reporting the prevalence of mucormycosis among COVID-19 patients were eligible for inclusion. Two investigators independently screened the articles against the selection criteria, extracted the data, and performed the quality assessment using the JBI tool. The pooled prevalence of CAM was the primary outcome, and the pooled prevalence of diabetes, steroid exposure, and the mortality rate were the secondary outcomes of interest. Comprehensive Meta-Analysis software version 2 was used for performing the meta-analysis. This meta-analysis comprised six studies with a pooled sample size of 52,916 COVID-19 patients with a mean age of 62.12 ± 9.69 years. The mean duration of mucormycosis onset was 14.59 ± 6.88 days after the COVID-19 diagnosis. The pooled prevalence of CAM (seven cases per 1000 patients) was 50 times higher than the highest recorded background of mucormycosis (0.14 cases per 1000 patients). A high mortality rate was found among CAM patients with a pooled prevalence rate of 29.6% (95% CI: 17.2–45.9%). Optimal glycemic control and the judicious use of steroids should be the approach for tackling rising CAM cases.

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Section: Discussionmentioning

confidence: 99%

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Hussain

Riad

Singh

et al. 2021

JoF

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“…Secondly, this was an observational and retrospective study, and other treatment factors may interfere with the outcomes. Previous studies revealed that systemic corticosteroids were frequently administered in patients with Covid-19 ( 3 , 24 ) and corticosteroids treatment reduced the all-cause mortality ( 31 ). In the present study, five of 12 patients (41.7%) in the ulinastatin treatment group and five of 15 patients (33.3%) in the standard care group received systemic methylprednisolone treatment.…”

Section: Discussionmentioning

confidence: 99%

Treatment of patients with Covid‑19 with a high dose of ulinastatin

Huang

Sun

et al. 2021

Exp Ther Med

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Currently, there are no specific therapeutic agents available for the treatment of coronavirus disease 2019 . The present study aimed to assess the efficacy of high-dose ulinastatin for the treatment of patients with Covid-19. A total of 12 patients hospitalized with confirmed severe acute respiratory syndrome coronavirus 2 infection were treated with a high dose of ulinastatin alongside standard care. Changes in clinical manifestations, laboratory examinations and chest images were retrospectively analyzed. A total of 10 patients with severe Covid-19 and two patients with moderate Covid-19 received ulinastatin treatment. The average age of the patients was 68.0±11.9 years (age range, 48-87 years). In total, nine of the 12 patients (75.0%) had one or more comorbidities. The most common symptoms on admission were fever (8/12, 66.7%), cough (5/12, 41.7%) and dyspnea (5/12, 41.7%). The percentage of lymphocytes was decreased in 41.7% of patients (5/12) and 58.3% of patients (7/12) had elevated hypersensitive C-reactive protein (CRP) levels (mean, 49.70±77.70 mg/l). The white blood cell levels and the percentage of lymphocytes returned to normal in all of the patients, and CRP was significantly decreased and returned to normal in 83.3% of patients (10/12; mean, 6.87±6.63 mg/l) on day 7 after ulinastatin treatment. Clinical symptoms were relieved synchronously. The peripheral oxygen saturation improved and 66.7% of the patients (8/12) did not require further oxygen therapy 7 days after ulinastatin treatment. No patients required intensive care unit admission or mechanical ventilation. All patients revealed different degrees of absorption of pulmonary lesions after treatment. Compared with the standard care group, ulinastatin treatment significantly prevented illness deterioration. In conclusion, these preliminary data revealed that high-dose ulinastatin treatment was safe and exhibited a potential beneficial effect for patients with Covid-19.

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“…Another study by Wagner. C et al [ 15 ] identified the favorable effects of steroids in reducing mortality and need for invasive ventilation in hospitalized COVID-19 patients.…”

Section: Discussionmentioning

confidence: 99%

Comparison of Low-Versus High-Dose Steroids in the Clinical Outcome of Hospitalized COVID-19 Patients

et al. 2021

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(1) Objectives: Patients with COVID-19 infection have been given various formulations and dosages of steroids over the last year and a half. This study aims to compare the effects of different formulations and doses of steroids on the 30 day in-hospital clinical outcome of patients with severe COVID-19 infection. (2) Material and Methods: An analysis of a retrospective cohort was carried out on patients with severe COVID-19 infection in a high-dependency unit (HDU) between February and July 2021. In total, 557 patients were included in this study. Patients who did not receive steroids (124) were excluded. Patients were divided into three groups based on dosages of steroids (Dexamethasone = 6 mg/day, Dexamethasone > 6 mg/day, and Methylprednisolone = 500 mg/day), given for 10 days. First, clinical outcome was evaluated on the 10th day of steroid administration in relation to mode of oxygen delivery. Then, Kaplan–Meier analysis was employed to determine 30 day in-hospital survival in relation to the use of steroid. (3) Results: Three groups were statistically equal according to biochemical characteristics. After 10 days of Methylprednisolone = 500 mg/day vs. Dexamethasone = 6 mg/day, 10.9% vs. 6.2% of patients required invasive ventilation (p = 0.01). The 30 day in-hospital mortality was lowest, 3%, in individuals receiving Dexamethasone = 6 mg/day, compared to 3.9% in individuals receiving Dexamethasone > 6 mg/day and 9.9% in individuals receiving Methylprednisolone = 500 mg/day, respectively. The median elapsed time was longer than 28 days between admission and outcome for Dexamethasone = 6 mg/day, compared to 18 days for Dexamethasone > 6 mg/day and 17 days for Methylprednisolone = 500 mg/day (p = < 0.0001). Dexamethasone = 6 mg/day was found to be a positive predictor of clinical outcome in COVID-19 patients on regression analysis. (4) Conclusions: Low-dose Dexamethasone (6 mg/day) is more effective than high-dose Dexamethasone and Methylprednisolone in improving the survival outcome of severe COVID-19 cases.

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Systemic corticosteroids for the treatment of COVID-19

Cited by 162 publications

References 74 publications

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Global Prevalence of COVID-19-Associated Mucormycosis (CAM): Living Systematic Review and Meta-Analysis

Treatment of patients with Covid‑19 with a high dose of ulinastatin

Comparison of Low-Versus High-Dose Steroids in the Clinical Outcome of Hospitalized COVID-19 Patients

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