Effectiveness and safety of glucocorticoids to treat COVID-19: a rapid review and meta-analysis

Abstract

Background: Glucocorticoids are widely used in the treatment of various pulmonary inflammatory diseases, but they are also often accompanied by significant adverse reactions. Published guidelines point out that low dose and short duration systemic glucocorticoid therapy may be considered for patients with rapidly progressing coronavirus disease 2019 (COVID-19) while the evidence is still limited.Methods: We comprehensively searched electronic databases and supplemented the screening by conducting a manual search. We included randomized controlled trials (RCTs) and cohort studies evaluating the effectiveness and safety of glucocorticoids in children and adults with COVID-19, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and conducted meta-analyses of the main indicators that were identified in the studies.Results: Our search retrieved 23 studies, including one RCT and 22 cohort studies, with a total of 13,815 patients. In adults with COVID-19, the use of systemic glucocorticoid did not reduce mortality [risk ratio (RR) =2.00, 95% confidence interval (CI): 0.69 to 5.75, I 2 =90.9%] or the duration of lung inflammation [weighted mean difference (WMD) =−1 days, 95% CI: −2.91 to 0.91], while a significant reduction was found in the duration of fever (WMD =−3.23 days, 95% CI: −3.56 to −2.90). In patients with SARS, glucocorticoids also did not reduce the mortality (RR =1.52, 95% CI: 0.89 to 2.60, I 2 =84.6%), duration of fever (WMD =0.82 days, 95% CI: −2.88 to 4.52, I 2 =97.9%) or duration of lung inflammation absorption (WMD =0.95 days, 95% CI: −7.57 to 9.48, I 2 =94.6%). The use of systemic glucocorticoid therapy prolonged the duration of hospital stay in all patients (COVID-19, SARS and MERS).

Efficacy of various treatment modalities for nCOV‐2019: A systematic review and meta‐analysis

“…Use of corticosteroid treatment was found to be associated with higher mortality (RR 2.11; 95%CI 1.13 to 3.94) in nCOV-2019 and SARS patients in a meta-analysis of 15 studies conducted by Yang et al, 68 while three meta-analyses found that corticosteroid use did not worsen/improve mortality in patients with nCOV-2019, SARS-Cov and MERS-Cov. [69][70][71] Further, the meta-analysis by Li et al 70 also observed a delayed time to virus clearance in the corticosteroid group compared to controls (MD 3.78; 95%CI 1.16 to 6.41). The findings of our meta-analysis are also in line with the previously published meta-analyses on corticosteroids.…”

Longitudinal immune profiling of mild and severe COVID-19 reveals innate and adaptive immune dysfunction and provides an early prediction tool for clinical progression

“…While most patients with mild disease develop an appropriate immune response that culminates with viral clearance 3 , severe disease manifestations have been linked to lymphopenia and immune hyperresponsiveness leading to cytokine release syndrome (CRS) 1,2,4,5 . The most effective therapeutic approaches developed so far for severe cases involve either general immunosuppression with glucocorticoids 6 or selective neutralization of interleukin 6 (IL-6) with tocilizumab 7 , a monoclonal antibody used to manage CRS in indications such as rheumatoid arthritis 8 . The efficacy of these therapies strongly support a key role for immune dysregulation in the pathogenesis of COVID-19.…”

Role of adjunctive treatment strategies in COVID-19 and a review of international and national clinical guidelines

“…A search of the literature uncovered 3 articles examining the role of corticosteroids in patients with COVID-19. In a meta-analysis of systemic corticosteroid use in COVID-19 patients by Lu et al [22], the pooled results from 5 cohort studies found that corticosteroids did not reduce the risk of mortality (relative risk (RR) = 2.0, 95% CI: 0.7-5.8, I 2 = 90.9%), shorten the duration of pneumonia (weighted mean difference (WMD) = − 1.0 day, 95% CI: − 2.9 -0.9), or shorten hospital stay (WMD = 2.4 days, 95% CI: 1.4-3.4, I 2 = 0.0%) in COVID-19 patients. However, the duration of fever was significantly lower in COVID-19 patients who received corticosteroids than patients who did not receive corticosteroids (WMD = − 3.2 days, 95% CI: − 3.6 to − 2.9).…”