The effect of glucocorticoids on mortality in severe COVID-19 patients

Gao, Yu; Jiang, Zhong-Hui; Yang, Zhong-Bin; Jiang, Shiqin; Quan, Xiao‐Qing

doi:10.1097/md.0000000000027373

Cited by 11 publications

(10 citation statements)

References 40 publications

(185 reference statements)

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“…Patients 60 years of age or older receiving methylprednisolone had a lower mortality rate compared with patients receiving placebo . A recent meta-analysis study including observational studies and randomized trials involving different drugs suggested that treatment with corticosteroids reduces mortality and risk of progression to invasive mechanical ventilation in severe COVID-19 patients . Treatment with methylprednisolone has resulted in better clinical outcomes than treatment with dexamethasone, but larger randomized controlled studies are needed to confirm this finding. , …”

Section: Promising Covid-19 Therapiesmentioning

confidence: 99%

Two Years into the COVID-19 Pandemic: Lessons Learned

et al. 2022

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Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is a highly transmissible and virulent human-infecting coronavirus that emerged in late December 2019 in Wuhan, China, causing a respiratory disease called coronavirus disease 2019 (COVID-19), which has massively impacted global public health and caused widespread disruption to daily life. The crisis caused by COVID-19 has mobilized scientists and public health authorities across the world to rapidly improve our knowledge about this devastating disease, shedding light on its management and control, and spawned the development of new countermeasures. Here we provide an overview of the state of the art of knowledge gained in the last 2 years about the virus and COVID-19, including its origin and natural reservoir hosts, viral etiology, epidemiology, modes of transmission, clinical manifestations, pathophysiology, diagnosis, treatment, prevention, emerging variants, and vaccines, highlighting important differences from previously known highly pathogenic coronaviruses. We also discuss selected key discoveries from each topic and underline the gaps of knowledge for future investigations.

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Section: Promising Covid-19 Therapiesmentioning

confidence: 99%

Two Years into the COVID-19 Pandemic: Lessons Learned

et al. 2022

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“…A total of 2 randomized clinical trials showed that using intravenous corticosteroids could reduce mortality (35,36). These findings are confirmed in a recent meta-analysis (37). However, it is important to point out the difference between administration, i.e., intravenous vs. inhalation, and setting, i.e., during hospital admission vs. home medication.…”

Section: Discussionmentioning

confidence: 80%

Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19—Insights From the PRoVENT–COVID Study

et al. 2022

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The purpose of this study was to compare and understand differences in the use of low tidal volume ventilation (LTVV) between females and males with acute respiratory distress syndrome (ARDS) related to coronavirus disease 2019 (COVID-19). This is a post-hoc analysis of an observational study in invasively ventilated patients with ARDS related to COVID-19 in 22 ICUs in the Netherlands. The primary endpoint was the use of LTVV, defined as having received a median tidal volume (VT) ≤6 ml/kg predicted body weight (PBW) during controlled ventilation. A mediation analysis was used to investigate the impact of anthropometric factors, next to the impact of sex per se. The analysis included 934 patients, 251 females and 683 males. All the patients had ARDS, and there were no differences in ARDS severity between the sexes. On the first day of ventilation, females received ventilation with a higher median VT compared with males [6.8 (interquartile range (IQR) 6.0–7.6 vs. 6.3 (IQR 5.8–6.9) ml/kg PBW; p < 0.001]. Consequently, females received LTVV less often than males (23 vs. 34%; p = 0.003). The difference in the use of LTVV became smaller but persisted over the next days (27 vs. 36%; p = 0.046 at day 2 and 28 vs. 38%; p = 0.030 at day 3). The difference in the use LTVV was significantly mediated by sex per se [average direct effect of the female sex, 7.5% (95% CI, 1.7–13.3%); p = 0.011] and by differences in the body height [average causal mediation effect, −17.5% (−21.5 to −13.5%); p < 0.001], but not by the differences in actual body weight [average causal mediation effect, 0.2% (−0.8 to 1.2%); p = 0.715]. In conclusion, in this cohort of patients with ARDS related to COVID-19, females received LTVV less often than males in the first days of invasive ventilation. The difference in the use of LTVV was mainly driven by an anthropometric factor, namely, body height. Use of LTVV may improve by paying attention to correct titration of VT, which should be based on PBW, which is a function of body height.

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“…Some scholars suggest that corticosteroids in general are not expected to help as a class of drugs, but rather each steroid should be assessed individually because different drugs can be associated with a different number of genes [ 46 ]. Many published meta-analyses have evaluated the role of glucocorticoids in the COVID-19 epidemic, but they have not evaluated the comparison between glucocorticoids [ 45 , 47 – 51 ].…”

Section: Discussionmentioning

confidence: 99%

A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone

Hong

Wang

et al. 2023

BMC Infect Dis

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Objective The preferred agent of glucocorticoids in the treatment of patients with severe COVID-19 is still controversial. This study aimed to compare the efficacy and safety of methylprednisolone and dexamethasone in the treatment of patients with severe COVID-19. Methods By searching the electronic literature database including PubMed, Cochrane Central Register of Controlled Trials, and Web of Science, the clinical studies comparing methylprednisolone and dexamethasone in the treatment of severe COVID-19 were selected according to the inclusion criteria and exclusion criteria. Relevant data were extracted and literature quality was assessed. The primary outcome was short-term mortality. The secondary outcomes were the rates of ICU admission and mechanical ventilation, PaO2/FiO2 ratio, plasma levels of C-reactive protein (CRP), ferritin, and neutrophil/lymphocyte ratio, hospital stay, and the incidence of severe adverse events. Statistical pooling applied the fixed or random effects model and reported as risk ratio (RR) or mean difference (MD) with the corresponding 95% confidence interval (CI). Meta-analysis was performed using Review Manager 5.1.0. Results Twelve clinical studies were eligible, including three randomized controlled trials (RCTs) and nine non-RCTs. A total of 2506 patients with COVID-19 were analyzed, of which 1242 (49.6%) received methylprednisolone and 1264 (50.4%) received dexamethasone treatment. In general, the heterogeneity across studies was significant, and the equivalent doses of methylprednisolone were higher than that of dexamethasone. Our meta-analysis showed that methylprednisolone treatment in severe COVID-19 patients was related to significantly reduced plasma ferritin and neutrophil/lymphocyte ratio compared with dexamethasone, and that no significant difference in other clinical outcomes between the two groups was found. However, subgroup analyses of RCTs demonstrated that methylprednisolone treatment was associated with reduced short-term mortality, and decreased CRP level compared with dexamethasone. Moreover, subgroup analyses observed that severe COVID-19 patients treated with a moderate dose (2 mg/kg/day) of methylprednisolone were related to a better prognosis than those treated with dexamethasone. Conclusions This study showed that compared with dexamethasone, methylprednisolone could reduce the systemic inflammatory response in severe COVID-19, and its effect was equivalent to that of dexamethasone on other clinical outcomes. It should be noted that the equivalent dose of methylprednisolone used was higher. Based on the evidence of subgroup analyses of RCTs, methylprednisolone, preferably at a moderate dose, has an advantage over dexamethasone in the treatment of patients with severe COVID-19.

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The effect of glucocorticoids on mortality in severe COVID-19 patients

Cited by 11 publications

References 40 publications

Two Years into the COVID-19 Pandemic: Lessons Learned

Two Years into the COVID-19 Pandemic: Lessons Learned

Sex Differences in Use of Low Tidal Volume Ventilation in COVID-19—Insights From the PRoVENT–COVID Study

A systematic review and meta-analysis of glucocorticoids treatment in severe COVID-19: methylprednisolone versus dexamethasone

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