Antivirals With Adjunctive Corticosteroids Prevent Clinical Progression of Early Coronavirus 2019 Pneumonia: A Retrospective Cohort Study

Ooi, Say Tat; Parthasarathy, Purnima; Lin, Yi Chun; Nallakaruppan, Valliammai D/O; Ng, Shereen; Tan, T. Y.; Low, Sui Pheng; Tang, Terence

doi:10.1093/ofid/ofaa486

Cited by 5 publications

(5 citation statements)

References 18 publications

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“…The 631 studies were found after the initial search. After removing duplicates and primarily screening of titles, 34 articles were retrieved, of which 21 articles ( Villar et al, 2020 ; Salton et al, 2020 ; Petersen et al, 2020 ; Horby et al, 2021 ; Steroid SARI, 2020; Tomazini et al, 2020 ; Pontali et al, 2021 ; Rashad et al, 2021 ; Jamaati et al, 2021 ; Edalatifard et al, 2020 ; Ramiro et al, 2020 ; Tang et al, 2021 ; Corral-Gudino et al, 2021 ; Angus et al, 2020 ; Dequin et al, 2020 ; Liu et al, 2020 ; Ranjbar et al, 2021 ; Jeronimo et al, 2021 ; Fadel et al, 2020 ; Nelson et al, 2021 ; Ooi et al, 2020 ) were found to be appropriate for quantitative analysis as presented in Fig. 1 .…”

Section: Resultsmentioning

confidence: 99%

Use of steroids in COVID-19 patients: A meta-analysis

Thakur

Datusalia

Kumar

2022

European Journal of Pharmacology

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Background Emerging reports have shown the benefits of steroids in hospitalized COVID-19 patients as life-saving drugs. However, the use of steroids in COVID-19 patients is confusing among many physicians. Aim The aim of the current study was to find out the exact association of steroids in the deaths of COVID-19 patients. Methods The relevant studies were searched in PubMed, Google scholar, and Clinical trials registries till May 25, 2021 and sorted out based on inclusion and exclusion criteria. The quality of studies was assessed using a standard scale. The pooled odds ratio was calculated with a 95% confidence interval. The sensitivity and sub-group analyses were also done. The publication bias was assessed qualitatively. The Rev Man 5 was used for all analyses with a random-effect model. Results The quantitative analysis was done with 9922 patients (6265-male and 3657-females) from 21 relevant studies. The pooled estimate results i.e. 0.52 [0.34, 0.80] have shown a significant reduction in deaths of COVID-19 patients in the steroidal group as compared to the non-steroidal group. The sensitivity analyses did not alter our conclusions. In subgroup analysis, methylprednisolone has shown a significant reduction in deaths of COVID-19 patients as compared to the non-steroidal group, however, more clinical evidence is required for dexamethasone and hydrocortisone. Conclusion The use of steroids in hospitalized COVID-19 patients is useful to reduce deaths.

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Section: Resultsmentioning

confidence: 99%

Use of steroids in COVID-19 patients: A meta-analysis

Thakur

Datusalia

Kumar

2022

European Journal of Pharmacology

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“…[ 36 ] In the study by Ooi et al ., 2020, stage 3 patients requiring supplemental oxygen were considered under severe category. [ 41 ] In the study by Fadel et al's., 2020 included a population which either required supplemental oxygen or mechanical ventilation, so the study population were considered under severe to critical category. [ 42 ] Monreal et al ., 2020 recruited COVID-19 patients who developed ARDS.…”

Section: Resultsmentioning

confidence: 99%

“…In the study by Ooi Say Tat et al ., 2020[ 41 ] patients were divided into 3 categories on the basis of severity: stage 1, stage 2, and stage 3. Stage 3 patients requiring supplemental oxygen were considered under severe disease, while stage 1 and 2 not requiring supplemental oxygen were considered under mild to moderate category.…”

Section: Resultsmentioning

confidence: 99%

“…A single study by Ooi Say Tat et al ., 2020[ 41 ] reported the requirement of mechanical ventilation among patients who were treated with steroids + SOC and were suffering from mild to moderate disease at the initiation of the study. However, “no significant difference” was seen between the two arms with regards to the requirement of mechanical ventilation [ ].…”

Section: Resultsmentioning

confidence: 99%

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Efficacy and safety of steroid therapy in COVID-19: A rapid systematic review and Meta-analysis

et al. 2020

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PURPOSE: Although the use of steroids in the management of COVID-19 has been addressed by a few systematic review and meta-analysis, however, they also used data from “SARS-CoV” and “MERS-CoV.” Again, most of these studies addressed only one severity category of patients or addressed only one efficacy endpoint (mortality). In this context, we conducted this meta-analysis to evaluate the efficacy and safety of steroid therapy among all severity categories of patients with COVID-19 (mild to moderate and severe to critical category) in terms of “mortality,” “requirement of mechanical ventilation,” “requirement of ICU” and clinical cure parameters. METHODS: 11 databases were screened. Only randomized controlled trials (RCTs) or high quality (on the basis of risk of bias analysis) comparative-observational studies were included in the analysis. RevMan5.3 was used for the meta-analysis. RESULTS: A total of 15 studies (3 RCT and 12 comparative-observational studies) were included. In the mechanically-ventilated COVID-19 population, treatment with dexamethasone showed significant protection against mortality (single study). Among severe and critically ill combined population, steroid administration was significantly associated with lowered mortality (risk ratio [RR] 0.83 [0.76–0.910]), lowered requirement of mechanical ventilation (RR 0.59 [0.51–0.69]), decreased requirement of intensive care unit (ICU) (RR 0.62 [0.45–0.86]), lowered length of ICU stay (single-study) and decreased duration of mechanical ventilation (two-studies). In mild to moderate population, steroid treatment was associated with a higher “duration of hospital stay,” while no difference was seen in other domains. In patients at risk of progression to “acute respiratory distress syndrome,” steroid administration was associated with “reduced requirement of mechanical ventilation” (single-study). CONCLUSION: This study guides the use of steroid across patients with different severity categories of COVID-19. Among mechanically ventilated patients, steroid therapy may be beneficial in terms of reduced mortality. Among “severe and critical” patients; steroid therapy was associated with lowered mortality, decreased requirement of mechanical ventilation, and ICU. However, no benefit was observed in “mild to moderate” population. To conclude, among properly selected patient populations (based-upon clinical severity and biomarker status), steroid administration may prove beneficial in patients with COVID-19.

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“…In another study Dexamethasone with other antiviral drug (remdesivir or favipiravir), it was observed that the use of steroids within ten days of beginning antiviral medications considerably reduces the probability of ICU hospitalization in the early stages of the disease [123] . Corticosteroid was also studied in combination with hydroxychloroquine, an antiviral drug, against hospitalized adults with COVID-19, and result exhibited that the combination of corticosteroid and antiviral drug was related to a reduced risk of clinical development, particularly in patients with pneumonia [124] . Corticosteroids-favipiravir combination treatment was also showed a better result in for improving the condition of COVID-19 patients with chronic obstructive pulmonary disease [125] .…”

Section: Synthesis Of Glucocorticoidsmentioning

confidence: 99%