Impact of systemic corticosteroids on hospitalized patients with COVID-19: January 2021 Meta-analysis of randomized controlled trials

Abstract

Background: The COVID-19 pandemic has stimulated worldwide investigation into a myriad of potential therapeutic agents, including corticosteroids. The first RCT reporting results on the impact of systemic corticosteroids on COVID-19 in a peer reviewed journal was the RECOVERY trial published in July, 2020. The RECOVERY trial showed a reduced risk of 28-day mortality in patients who received oral or intravenous dexamethasone for 10 days. This study is a meta-analysis of peer reviewed RCTs aims to estimate the association of systemic corticosteroid therapy compared to the usual care or placebo on all-cause mortality in hospitalized patients with COVID-19. Software based tools to accelerate the analysis process. Methods: Meta-analysis of peer reviewed RCTs comparing systemic corticosteroids to usual care or placebo. Results: Five English language RCTs were identified, including data from 7645 hospitalized patients worldwide using systemic dexamethasone, hydrocortisone and methylprednisolone in COVID-19 positive patients. Three RCTs were discontinued when preliminary results from the RECOVERY trial became available. Meta-analysis of all identified RCTs showed no difference in survival in patients who received systemic corticosteroid therapy compared to usual care or placebo (Odds ratio 0.82, 95% CI 0.64-1.05, p = 0.09). Subgroup analysis from the 1967 critically ill patients in the identified RCTs showed improved survival in patients who received systemic corticosteroid therapy (Odds ratio 0.67, 95% CI 0.51-0.87, p = 0.01). Conclusions: This meta-analysis of randomized controlled trials published in peer-reviewed literature by January 1, 2021 showed reduced mortality in critically ill patients but not all hospitalized patients with COVID-19 who received systemic corticosteroids. The early termination of three of the included RCTs because of the preliminary results of the RECOVERY trial is likely to have dramatically influenced the results of this meta-analysis. Further research is needed to clarify the role of systemic corticosteroid therapy in the management of COVID-19.

COVID-19, the Pandemic of the Century and Its Impact on Cardiovascular Diseases

“…[301] Several meta-analyses indicated that corticosteroids remain effective and safe among severely ill COVID-19 patients, but not among all hospitalized COVID-19 patients. [302][303][304] Accordingly, the WHO guidelines recommend corticosteroid administration for patients with severe COVID-19 or those critically ill with the disease, but not for patients with non-severe COVID-19. [305] A recent study from Wuhan, China, assessed the effect of lowdose aspirin on COVID-19 patients who also had CAD.…”

Pain in COVID-19: Quis est culpa?

“…Corticosteroid drug has been a subject of various studies, including Recovery which validated its efficacy and brought excellent news [12]. Dexamethasone cannot treat COVID-19, but as has been mentioned, it effectively reduces the massive inflammation that develops in this disease and causes many deaths [13,14]. WHO issues guidelines on the treatment of various diseases.…”

“…It is cheap, available, effective and can save many lives. Guidelines recommend using intravenous or tablet form of the corticosteroid therapy with Dexamethasone in patients with a severe course of the disease [13,14]. Prevention of complications is always better than their later management.…”

“…No improvements have been seen in patients with a milder course of the disease. The following adverse effects of corticosteroids may develop, depending on the dosage and duration of the treatment, which means that the frequency of their occurrence cannot be established (Table 1) [13,15,16]. Antiviral agents (remdesivir, lopinavir-ritonavir, hydroxychloroquine, tocilizumab) were also tested in the previous months (originally against ebola, malaria and AIDS [acquired immunodeficiency syndrome]) with high expectations of scientists.…”