Corticosteroids in COVID-19: Is it Rational? A Systematic Review and Meta-Analysis

Abstract

Due to a lack of definitive treatment, many drugs were repurposed for Coronavirus disease (COVID-19) treatment; among them, corticosteroid is one. However, its benefit or harm while treating COVID-19 is not fully studied. Thus, we conducted this meta-analysis to assess the rationality on the use of corticosteroids in COVID-19. Pubmed, Medline, Clinicaltrials.gov, Cochrane library, and Preprint publisher were searched. In the qualitative syntheses, 41, and quantitative studies, 40, were included using PRISMA guidelines. Assessment of heterogeneity was done using the I-squared (I 2) test and random/fixed effect analysis was done to determine the odds/risk ratio. We found severely ill COVID-19 patients almost 5 (OR 4.78, 2.76-8.26) times higher odds of getting corticosteroids during their treatment. Similarly, the odds for corticosteroids in addition to standard of care (SOC) were approximately 4 (OR 4.09, 1. 89-8.84) times higher among intensive care unit (ICU) patients than non-ICU ones. A higher mortality risk with the corticosteroidreceiving group compared with the SOC alone (RR 2.01, 1.12-3.63) was observed. Neither increased discharge rate (RR 0.79, 0.63-0. 99) nor recovery/improvement rate was shown among the corticosteroid-receiving group (OR 0.24, 0.13-0.43). Approximately, the overall 4-day longer hospital stay was found among the treatment groups (MD 4.19, 2.57-5.81). For the negative conversion of reverse transcription-polymerase chain reaction (RT-PCR), approximately a 3-day (MD 2.42, 1.31-3.53) delay was observed with corticosteroid treatment cases. Our study concludes that more severe and critically ill patients tend to get corticosteroids, and the mortality risk increases with the use of corticosteroids. With the use of corticosteroids, delayed recovery and a longer hospital stay were observed.

Comparison of Associations Between Glucocorticoids Treatment and Mortality in COVID-19 Patients and SARS Patients: A Systematic Review and Meta-Analysis

“…As of writing this manuscript (early November 2020), 16 meta-analyses 3,[104][105][106][107][108][109][110][111][112][113][114][115][116][117][118] have examined the use of glucocorticoids in patients with COVID-19 or coronavirus infections. Regarding mortality, 4 metaanalyses 3,106,111,112,117 included RCTs (1 including 7 RCTs, 3 including 1 or 2 RCTs) and the rest only included observational studies.…”

“…Regarding mortality, 4 metaanalyses 3,106,111,112,117 included RCTs (1 including 7 RCTs, 3 including 1 or 2 RCTs) and the rest only included observational studies. Of these meta-analyses, 5 3,[104][105][106][107] found that glucocorticoids treatment decreased all-cause mortality, 7 [108][109][110][111][112][113][114] found no association between glucocorticoids treatment and allcause mortality, and the others [115][116][117][118] found glucocorticoids treatment increased all-cause mortality. In general, meta-analyses that supported glucocorticoids treatment mostly identi ed studies on COVID-19 patients who were severely-ill or with ARDS.…”

Anti-Inflammatory Effects of Amantadine and Memantine: Possible Therapeutics for the Treatment of Covid-19?

“…According to this review, dexamethasone has been considered as a standard in the treatment of COVID-19, especially in severe cases, since a study conducted in the UK showed a 35% reduction in mortality rate in patients with mechanical ventilation and a 20% reduction in the mortality rate in patients who were given oxygen [ 38 ]. In contrast, a recent meta-analysis questioned the efficacy of corticosteroids in COVID-19, concluding that “with the use of corticosteroids, delayed recovery and a longer hospital stay were observed” [ 39 ]. Together with dexamethasone, remdesivir has been authorized and recommended for the therapy of COVID-19 in the US, where two studies have shown that this drug accelerated the patient’s recovery compared to placebo, and reduced hospitalization period [ 37 ].…”

Corticosteroids for COVID-19

“…Table 3 summarizes the characteristics and main finding from 13 systematic reviews and meta-analyses published since March 2020 67 , 68 , 69 , 70 , 71 , 72 , 73 , 74 , 75 , 76 , 77 , 78 , 79 . Two of these systematic reviews included only randomized controlled trials 76 , 77 .…”