Corticosteroid Treatment in Patients With Severe Covid-19 Pneumonia

Pourafkari

Pulmonary Pharmacology & Therapeutics

et al. 2022

Background Covid-19 disease is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Although corticosteroids have shown some promising results in Covid-19 patients, their effectiveness remains controversial. In this systematic review, we evaluated the effect of corticosteroids in mortality, Hospitalization, ICU admission, intubation, and mechanical ventilation in Covid-19 patients. Methods We searched major databases from March-2020 to Jan-2021. Twenty-nine studies were included after evaluating the eligibility of the literature. The extracted data for mortality, hospitalization, admission to the ICU, intubation, and mechanical ventilation were analyzed with RevMan® 5.4. Categorical variables are presented with odds ratios (OR), and numerical variables are shown with the mean difference. Result Corticosteroid treatment had no impact on mortality in 18,190 covid patients with OR = 1.12[0.83–1.50]. When we include the randomized controlled trials, corticosteroids reduced the mortality by 20% (OR = 0.80 [0.73, 0.88]; P < 0.001). Additionally, the risk of admission to the ICU, the need for endotracheal intubation, and mechanical ventilation were comparable between patients receiving corticosteroids and controls. The duration of hospitalization was also similar in the two groups. Conclusion Corticosteroid therapy may not be effective for reducing mortality, length of hospitalization, the likelihood of intubation and mechanical ventilation, and ICU admission in patients suffering from Covid-19 pneumonia.

Section: Resultsmentioning

confidence: 99%

Effects of corticosteroids on Covid-19 patients: A systematic review and meta-analysis on clinical outcomes

Pourafkari

Pulmonary Pharmacology & Therapeutics

et al. 2022

Neuromuscular Disorders

“…In some DMD cases, the dose of corticosteroids should be increased in order to meet standard infection/stress steroid protocols [16] when febrile illness begins. Recent studies support the benefit of corticosteroid usage in the treatment of COVID-19 patients [22], as an early course of corticosteroids may attenuate progression to the hyperinflammation phase of COVID-19 that requires an escalation of care [23]. It is not known whether chronic corticosteroid treatment may protect from severe COVID-19 disease.…”

Section: Discussionmentioning

confidence: 99%

COVID-19 in advanced Duchenne/Becker muscular dystrophy patients

Levine

Prais

Aharoni

et al. 2021

Duchenne muscular dystrophy (DMD) is the most common childhood muscular dystrophy. As a result of progressive muscle weakness, pulmonary function decreases during the second decade of life and lung disease contributes significantly to morbidity and mortality in these patients. Corticosteroids are the current standard of care for patients with DMD, despite known adverse effects such as obesity and immunosuppression. Over the past year (2020), the novel coronavirus (COVID-19/SARS-CoV2) outbreak has caused a global pandemic. Restrictive lung disease due to low lung volumes, chronic immunosuppressive treatment with corticosteroids, and obesity are potential risk factors that may contribute to a more severe course of the disease. Out of 116 Duchenne/Becker muscular dystrophy patients treated in our tertiary neuromuscular center, six patients with DMD and one with advanced Becker muscular dystrophy were found to be positive for COVID-19 infection. Two of the DMD patients were admitted for hospitalization, of whom one was dependent on daily nocturnal non-invasive ventilation. All patients recovered without complications despite obesity, steroid treatment and severe restrictive lung disease.

“…All 24 of our selected articles compared outcomes of corticosteroid with the control group and our primary outcome mortality was recorded in all 24 studies [13,30,[39][40][41][42][43][44][45][46][47][48]31,[49][50][51][52][32][33][34][35][36][37][38].…”

Section: Description Of the Selected Studiesmentioning

confidence: 99%

“…Length of hospital stay (days) was analyzed in 3 studies [13,48,50], secondary infection rate was recorded in 12 studies [32,37,50,51,[42][43][44][45][46][47][48][49], length of mechanical ventilation was recorded in 5 studies [39,42,[49][50][51], number of patients in mechanical ventilation (MV) was presented in 14 studies [13,31,48,50,51,33,34,38,41,42,[45][46][47], length of ICU stay (days) was reported in 6 studies [13,43,[48][49][50][51]. Twenty-three articles included patients with the respiratory viral infection and one article included patients with acute respiratory distress syndrome.…”

Section: Description Of the Selected Studiesmentioning

confidence: 99%

Differential effect of corticosteroid treatment on Influenza, SARS, MERS, and SARS-CoV-2 patients: A meta-analysis and systematic review

Ali

Uddin

Dewan

et al. 2021

Preprint

Background: Corticosteroid has been used to manage inflammation caused by many diseases including respiratory viral infections. Many articles are available to support the good and bad side of this steroid use but remain inconclusive. To find some evidence about the safety of the drug, we investigated the effect of corticosteroids on the mortality of patients with respiratory viral infections including SARS-CoV-2, SARS, MERS, and Influenza. Method: We searched articles in PubMed, Scopus, Cochrane, Medline, Google Scholar, and Web of Science records using the keywords corticosteroid or viral infection or patients or control study. Mortality was the primary outcome. Result: Our selected 24 studies involving 16633 patients were pooled in our meta-analysis. Corticosteroid use and overall mortality were not significantly associated (P=0.176), but in subgroup analysis, corticosteroid use was significantly associated with lower mortality in the case of SARS (P=0.003) but was not significantly associated with mortality for Influenza (H1N1) (P=0.260) and SARS-CoV-2 (P=0.554). Further analysis using study types of SARS-CoV-2, we found that corticosteroid use was not significantly associated with mortality in the case of retrospective cohort studies (P=0.256) but was significantly associated with lower mortality in the case of randomized control trials (P=0.005). Our findings uncover how the outcome of particular drug treatment for different diseases with comparable pathogenesis may not be similar and, RCTs are sometimes required for robust outcome data. Conclusion: At the beginning of the COVID-19 pandemic, data of corticosteroid use from other viral infections along with COVID-19 observational and retrospective cohort studies created confusion of its effect, but randomized control trials showed that corticosteroid can be used to treat COVID-19 patients.