High-Dose versus Low-Dose Corticosteroids in COVID-19 Patients: a Systematic Review and Meta-analysis

Tan, Rachel Si Jing; ng, Ka Ti; Xin, Chua Ee; Atan, Rafidah; Yunos, Nor’azim Mohd; Hasan, Mohd Shahnaz

doi:10.1053/j.jvca.2022.05.011

Cited by 21 publications

(24 citation statements)

References 45 publications

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“…A systematic review and meta-analysis of high-dose versus low-dose corticosteroids in patients with COVID-19, including 12 observational studies and randomized controlled trials, demonstrated that high-dose corticosteroids did not reduce mortality [ 22 ]. The authors also admitted the limitation of a high degree of heterogeneity due to inconsistency of the dosage, types, and regimens among the reported studies and lack of subgroup analysis based on severity due to limited data.…”

Section: Discussionmentioning

confidence: 99%

Low-dose versus high-dose dexamethasone for hospitalized patients with COVID-19 pneumonia: A randomized clinical trial

Daouk

Kebbe

et al. 2022

PLoS ONE

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Background Dexamethasone 6 mg daily for 10 days is the recommended treatment for patients with severe or critical coronavirus disease 2019 (COVID-19). The evidence on the benefit of high-dose dexamethasone is limited. The goal of this study was to assess the effects of 6 mg daily vs. 20 mg daily of dexamethasone in hospitalized patients with COVID-19 pneumonia. Methods We conducted a single-center, randomized, clinical trial involving hospitalized patients with COVID-19 pneumonia. Participants were randomized 1:1 to dexamethasone 6 mg daily or dexamethasone 20 mg daily, and were stratified by the WHO-Ordinal Scale for Clinical Improvement (OSCI). The primary outcome was clinical improvement equal to or greater than 2 points by OSCI on day 28. Secondary outcomes were 28-day mortality, intensive care unit-free days, and ventilator-free days on day 28. Results Of the 107 patients who enrolled and completed the follow up, 55 patients enrolled in the low-dose group and 52 patients enrolled in the high-dose group. Treatment with dexamethasone 20 mg daily compared with dexamethasone 6 mg daily did not result in better clinical improvement based on OSCI on day 28 (71.2% vs. 78.2%; odds ratio, 1.45 [0.55–3.86]; p = 0.403). For participants who required high-flow oxygen or noninvasive ventilation at randomization, the 6-mg group had better survival than the 20-mg group on day 28 (100% vs. 57.1%; p = 0.025). Although more participants in the 6-mg group received immune modulators (40% vs. 21.2%; p = 0.035), 50% of death cases in the 20-mg group who required high-flow oxygen or noninvasive ventilation at randomization received immune modulators. Conclusions Dexamethasone 20 mg daily did not result in better clinical outcome improvement, and was probably associated with higher 28-day mortality in patients on high-flow oxygen or noninvasive ventilation, compared with dexamethasone 6 mg daily. Trial registration Clinialtrials.gov number, NCT04707534, registered January 13, 2021

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Section: Discussionmentioning

confidence: 99%

Low-dose versus high-dose dexamethasone for hospitalized patients with COVID-19 pneumonia: A randomized clinical trial

Daouk

Kebbe

et al. 2022

PLoS ONE

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“…For the outcome mortality, low-dose steroids were found as effective as high-dose steroids in 2 comparisons from a SR (certainty of evidence from low to very-low) [39]. Low-dose steroids were found more effective than SOC in 2 SRs (certainty of evidence low and moderate) [30,44], and as effective as SOC in one SR (VL certainty of evidence) [31].…”

Section: Steroids Regimensmentioning

confidence: 98%

“…For the outcome progression of disease (need for mechanical ventilation in 4 SRs, and admission to ICU in one), low-dose steroids were found as effective as high-dose steroids in 2 SRs [39,42], and more effective than SOC in one SR [44] (from very-low to low certainty of evidence). High-dose steroids were found as effective as SOC in one SR (low certainty of evidence) [44].…”

Section: Steroids Regimensmentioning

confidence: 99%

“…High-dose steroids were found as effective as SOC in one SR (low certainty of evidence) [44]. Length of hospital stay was similar among patients receiving non-pulse dose or pulse-dose steroids [46], and in patients receiving high-dose or low-dose steroids (from low to very-low certainty of evidence) [39]. Likewise, no clear difference in the occurrence of hyperglicemia and secondary infections were found among low-dose and highdose steroids recipients (moderate certainty of evidence) [39].…”

Section: Steroids Regimensmentioning

confidence: 99%

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Untitled

2022

infez med

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A reappraisal of the validity of the conclusions of systematic reviews (SRs) and meta-analyses related to corticosteroids use for the treatment of COVID-19. Material and Methods: An overview of SRs (umbrella review). The methodological quality of the SRs was assessed using tha AMSTAR-2 checklist; quality of the evidence was appraised following the GRADE approach. Results: 35 SRs were included in this overview. Data were from 307 overlapping reports, based on 121 individual primary studies (25 randomized clinical trials (RCTs), 96 non-RCTs. In critically ill patients the use of steroids significantly reduced mortality compared to standard of care in 80% of the SRs, more often with moderate/high level of certainty; however, in patients not requiring oxygen supplementation the use of steroids increased the overall mortality in 2/3 of the comparisons. Clinical progression of diseases (need for me-chanical ventilation, or for intensive care admission) was more commonly observed among controls compared to steroids recipients (in 9 out of 14 comparisons; certainty of evidence from very-low to moderate). The occurrence of adverse events was similar among steroids recipients and controls. Other outcomes (i.e., viral clearance, length of hospital stay) or issue related to optimal dose and type of steroids were addressed in a minority of SRs, with a high level of uncertainty, so that no definitive conclusions can be drawn. Conclusions: There is moderate certainty of evidence that corticosteroids reduce mortality and progression of disease in critically ill COVID-19 patients compared to standard of care, without increasing the occurrence of adverse events.

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“…v. täglich für 10 Tage. Es zeigte sich bislang keine Evidenz für eine Überlegenheit von höheren Dosen hinsichtlich der Sterblichkeit 12 .…”

Section: Medikamentöse Therapieunclassified

Medikamentöse Therapiemaßnahmen bei akuter SARS-CoV-2-Infektion: wer, wann und was?

Sensen¹,

Wichmann²,

Kluge³

2022

Dtsch Med Wochenschr

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Mittlerweile gibt es eine Vielzahl von medikamentösen Therapieoptionen zur Behandlung einer akuten SARS-CoV-2-Infektion. Die aktualisierte S3-Leitlinie „Empfehlungen zur stationären Therapie von Patienten mit COVID-19“ gibt dazu klare Empfehlungen. Welche Therapie für welchen Patienten und in welcher Krankheitsphase am besten geeignet ist, muss individuell anhand der Risikofaktoren, der Komorbiditäten und der Kontraindikationen entschieden werden. Hierüber geben wir in diesem Beitrag einen Überblick.

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High-Dose versus Low-Dose Corticosteroids in COVID-19 Patients: a Systematic Review and Meta-analysis

Cited by 21 publications

References 45 publications

Low-dose versus high-dose dexamethasone for hospitalized patients with COVID-19 pneumonia: A randomized clinical trial

Low-dose versus high-dose dexamethasone for hospitalized patients with COVID-19 pneumonia: A randomized clinical trial

Untitled

Medikamentöse Therapiemaßnahmen bei akuter SARS-CoV-2-Infektion: wer, wann und was?

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