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Impact of Corticosteroids in Coronavirus Disease 2019 Outcomes: Systematic Review and Meta-analysis
Edison J Cano1, Xavier Fonseca Fuentes2, Cristina Corsini Campioli1
1Division of Infectious Disease, Mayo Clinic, Rochester, MN.
Background:
Since its appearance in late 2019, infections caused by severe acute respiratory syndrome coronavirus 2 have created unprecedented challenges for health systems worldwide. Multiple therapeutic options have been explored, including corticosteroids. Preliminary results of corticosteroids in coronavirus disease 2019 (COVID-19) are encouraging; however, the role of corticosteroids remains controversial.
Research Question:
What is the impact of corticosteroids in mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients?
Study Design And Methods:
We conducted a systematic review of literature on corticosteroids and COVID-19 in major databases (PubMed, MEDLINE, and EMBASE) of published literature through July 22, 2020, that report outcomes of interest in COVID-19 patients receiving corticosteroids with a comparative group.
Results:
A total of 73 studies with 21,350 COVID-19 patients were identified. Corticosteroid use was reported widely in mechanically ventilated patients (35.3%), ICU patients (51.3%), and severe COVID-19 patients (40%). Corticosteroids showed mortality benefit in severelly ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006); however, no beneficial or harmful effects were noted among high-dose or low-dose corticosteroid regimens. Emerging evidence shows that low-dose corticosteroids do not have a significant impact in the duration of SARS-CoV-2 viral shedding. The analysis was limited by highly heterogeneous literature for high-dose and low-dose corticosteroids regimens.
Interpretation:
Our results showed evidence of mortality benefit in severely ill COVID-19 patients treated with corticosteroids. Corticosteroids are used widely in COVID-19 patients worldwide, and a rapidly developing global pandemic warrants further high-quality clinical trials to define the most beneficial timing and dosing for corticosteroids.
Insights
Corticosteroids may reduce mortality in severely ill COVID-19 patients. This systematic review found a mortality benefit, but further trials are needed to determine optimal corticosteroid timing and dosage for severe acute respiratory syndrome coronavirus 2 infections.
Area of Science:
- Infectious Diseases
- Critical Care Medicine
- Pharmacology
Background:
- Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infections present global health challenges.
- Corticosteroids are explored as a therapeutic option for coronavirus disease 2019 (COVID-19).
- The precise role of corticosteroids in COVID-19 management remains debated.
Purpose of the Study:
- To systematically review the impact of corticosteroids on mortality, ICU admission, mechanical ventilation, and viral shedding in COVID-19 patients.
- To synthesize evidence from published literature on corticosteroid use in COVID-19.
Main Methods:
- Systematic literature review of studies on corticosteroids and COVID-19.
- Searched major databases (PubMed, MEDLINE, EMBASE) for relevant publications up to July 22, 2020.
- Included studies reporting outcomes in COVID-19 patients receiving corticosteroids with a comparative group.
Main Results:
- Analyzed 73 studies involving 21,350 COVID-19 patients.
- Corticosteroids demonstrated a mortality benefit in severely ill COVID-19 patients (OR, 0.65; 95% CI, 0.51-0.83; P = .0006).
- No significant impact on viral shedding was observed with low-dose corticosteroids; high-dose and low-dose regimens showed no clear benefit or harm.
Conclusions:
- Evidence suggests a mortality benefit of corticosteroids for severely ill COVID-19 patients.
- Widespread use of corticosteroids in COVID-19 necessitates high-quality clinical trials.
- Further research is crucial to establish optimal corticosteroid timing and dosing strategies.
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