Optimal Duration of Systemic Corticosteroids in Coronavirus Disease 2019 Treatment: A Systematic Review and Meta-analysis

Abstract

Background Corticosteroids confer a survival benefit in individuals hospitalized with COVID-19 that require oxygen. This meta-analysis seeks to determine the duration of corticosteroids needed to optimize this mortality benefit. Methods Electronic databases were searched to March 9, 2022, for studies reporting corticosteroid versus no corticosteroid treatment in hospitalized COVID-19 patients. We estimated the effect of corticosteroids on mortality by random-effects meta-analyses. Subgroup analyses and meta-analyses were conducted to assess the optimal duration of corticosteroid treatment while adjusting for the severity of disease, age, duration of symptoms, and proportion of control group given steroids. Results We identified 27 eligible studies consisting of 13,404 hospitalized COVID-19 patients. Seven randomized controlled trials and 20 observational studies were included in the meta-analysis of mortality, which suggested a protective association with corticosteroid therapy (risk ratio: 0.71; 95% CI: 0.58; 0.87). Pooled analysis of 18 studies showed the greatest survival benefit for a treatment duration up to 6 days (risk ratio, 0.54; 95% CI, 0.39; 0.74). Survival benefit was 0.65 (95% CI, 0.51; 0.83) up to 7 days, and no additional survival benefit was observed beyond 7 days of treatment (risk ratio: 0.64; 95% CI: 0.44; 0.93). The survival benefit was not confounded by severity of disease, age, duration of symptoms or proportion of control group given steroids. Conclusions In this meta-analysis, optimal duration of corticosteroid treatment for hospitalized COVID-19 patients was up to 6 days, with no additional survival benefit with > 7 days of treatment.

Clinical efficacy of various regimens of systemic glucocorticoids therapy in COVID-19 patients

“…Таким образом, в соответствии с нашими данными, а также данными других исследований оптимальная длительность использования ГК не должна превышать 7 сут. [17,[29][30][31].…”

“…P. Ssentongo на основе результатов исследования [17], выполненного на 13 404 пациентах, сделал вывод, что оптимальная продолжительность применения ГК у пациентов с COVID-19 тяжелого течения должна составлять до 6 сут., поскольку при лечении длительностью более 7 сут. отсутствует дополнительная польза от терапии и улучшение выживаемости пациентов.…”

Insights into COVID-19: Perspectives on Drug Remedies and Host Cell Responses

“…The WHO announced that only patients with severe or critical symptoms of COVID-19 should be administered dexamethasone (or other corticosteroids such as prednisolone and hydrocortisone), reiterating that mild cases do not benefit from the treatment [180]. This evidence comes from combined results of clinical trials that showed that deaths were reduced by 20% when patients with severe COVID-19 were given corticosteroid treatment during their illness, thus confirming the efficacy of corticosteroids during the hyperinflammatory stage of SARS-CoV-2 infection [181].…”