Background: The COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including corticosteroids. The first RCT reporting results on the impact of systemic corticosteroids on COVID-19 in a peer reviewed journal was the RECOVERY trial published in July, 2020. The RECOVERY trial showed a reduced risk of 28-day mortality in patients who received oral or intravenous dexamethasone for 10 days. This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of systemic corticosteroid therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process. Methods: Meta-analysis of peer reviewed RCTs comparing systemic corticosteroids to usual care or placebo. Results: Five English language RCTs were identified, including data from 7645 hospitalized patients worldwide using systemic dexamethasone, hydrocortisone and methylprednisolone in COVID-19 positive patients. Three RCTs were discontinued when preliminary results from the RECOVERY trial became available. Meta-analysis of all identified RCTs showed no difference in survival in patients who received systemic corticosteroid therapy compared to usual care or placebo (Odds ratio 0.82, 95% CI 0.64-1.05, p = 0.09). Subgroup analysis from the 1967 critically ill patients in the identified RCTs showed improved survival in patients who received systemic corticosteroid therapy (Odds ratio 0.67, 95% CI 0.51-0.87, p = 0.01). Conclusions: This meta-analysis of randomized controlled trials published in peer-reviewed literature by January 1, 2021 showed reduced mortality in critically ill patients but not all hospitalized patients with COVID-19 who received systemic corticosteroids. The early termination of three of the included RCTs because of the preliminary results of the RECOVERY trial is likely to have dramatically influenced the results of this meta-analysis. Further research is needed to clarify the role of systemic corticosteroid therapy in the management of COVID-19.

Background: The COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including antivirals such as remdesivir. The first RCT reporting results on the impact of remdesivir on COVID-19 in a peer reviewed journal was the ACTT-1 trial published in November, 2020. The ACTT-1 trial showed more rapid clinical improvement and a reduced risk of 28-day mortality in patients who received remdesivir. This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of remdesivir therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process. Methods: Meta-analysis of peer reviewed RCTs comparing remdesivir to usual care or placebo. The protocol for this meta-analysis was registered and published in the PROSPERO database (CRD42021229985) on February 5, 2021. Results: Four English language RCTs were identified, including data from 7,333 hospitalized patients worldwide using remdesivir in COVID-19 positive patients. Meta-analysis of all identified RCTs showed no difference in survival in patients who received remdesivir therapy compared to usual care or placebo. The random effects meta-analysis has a summary odd ratio is 0.89 (95% CI 0.65-1.21, p = 0.30). Considerable variability in the severity of illness is noted with the rates of IMV at the time of randomization ranging from 0% to 27%. Conclusions: This meta-analysis of randomized controlled trials published in peer-reviewed literature by February 1, 2021 did not show reduced mortality in hospitalized patients with COVID-19 who received remdesivir. Further research is needed to clarify the role of remdesivir therapy in the management of COVID-19.