Corticosteroids Treatment for Patients With Coronavirus Disease-2019 (COVID-19) With Different Disease Severity: a Systematic Review and Meta-analysis Protocol

Abstract

Introduction: As the coronavirus disease 2019 (COVID-19) pandemic progresses, identifying effective antiviral agents to treat the COVID-19 is of most urgency. Efficacy and safety of corticosteroids in patients with COVID-19 still are debated. Because high-quality randomized clinical trials (RCTs) on the use of corticosteroids for patients with COVID-19 recently were published recently, we aim to conduct a systematic review and meta-analysis of RCTs on corticosteroids therapy in patients with different disease severity to ascertain the effect on survival. Methods: We will undertake a comprehensive literature search among PubMed, EMBASE, Cochrane Library, medRxiv, and bioRxiv from their inception onwards to identify relevant RCTs. Two reviewers will independently extract data and conduct risk of bias assessments. The primary outcome is all-cause mortality, mortality of mechanically ventilated patients and patients who did not receive oxygen therapy. Secondary outcomes include need for mechanical ventilation or oxygen therapy and incidence of adverse outcomes. Heterogeneity of the estimates across studies will be assessed. Outcomes will be analyzed to pooled risk ratio and pertinent 95% confidence interval. A subgroup analysis will be conducted by disease severity to explore the source of heterogeneity. The systematic review and meta-analysis will be presented according to the Preferred Reporting Items for Systematic reviews and Meta-Analyses. Discussion: This systematic review will provide an overview of the current state of evidence concerning the effect of corticosteroids on survival of patients with COVID-19 depended on the disease severity. Also, this systematic review will show the limitations and strengths of the studies available in the literature, as well as recommendations for future avenues of research will be given. PROSPERO registration number: CRD42020227740.