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Effectiveness of corticosteroids to treat coronavirus disease 2019 symptoms: A meta-analysis
Yiqian Zeng1, Weizhong Zeng1, Bihui Yang2
1Department of Critical Care Medicine, Zhuzhou Central Hospital, Zhuzhou, Hunan, China.
Insights
Corticosteroids reduce mortality in severe COVID-19 patients but not in non-severe cases. Low-dose dexamethasone with prolonged treatment benefits all patients, though it may increase hospital stays for non-severe COVID-19.
Area of Science:
- Critical Care Medicine
- Infectious Diseases
- Pharmacology
Background:
- Corticosteroids are frequently used for coronavirus disease 2019 (COVID-19) symptom management.
- The clinical effectiveness of corticosteroids in COVID-19 treatment remains a subject of debate.
Purpose of the Study:
- To evaluate the efficacy of corticosteroid treatment in patients diagnosed with COVID-19.
- To determine the impact of corticosteroids on all-cause mortality and hospital stay duration.
Main Methods:
- A systematic review and meta-analysis of 9 randomized controlled trials (RCTs) involving 7907 patients.
- Searches were conducted across PubMed, Embase, and Cochrane Library databases.
- Primary endpoint: all-cause mortality; Secondary endpoint: length of hospital stay.
Main Results:
- Corticosteroid treatment significantly reduced all-cause mortality in COVID-19 patients (RR=0.88, P=0.002).
- A significant reduction in mortality was observed in severe COVID-19 cases (RR=0.77, P<0.0001), but not in non-severe cases (RR=0.96, P=0.41).
- Low-dose dexamethasone and longer treatment courses showed benefits for mortality. Non-severe cases experienced longer hospital stays (MD=3.83, P=0.006).
Conclusions:
- Corticosteroid therapy is associated with reduced all-cause mortality in severe COVID-19 patients.
- For non-severe COVID-19, corticosteroids do not decrease mortality and may extend hospital stays.
- Low-dose dexamethasone, administered over a longer duration, can decrease mortality in COVID-19 patients.
Objective:
Currently, corticosteroids are widely used to treat coronavirus disease 2019 (COVID-19) symptoms. However, the therapeutic role of corticosteroids remains highly controversial. To that end, we aimed to assess the efficacy of corticosteroids in treating COVID-19 patients.
Method:
We searched PubMed, Embase, and Cochrane Library to select suitable studies. Our primary study endpoint was all-cause mortality. The secondary study endpoint was the length of hospital stay.
Results:
A total of 9 randomized controlled trials (RCTs) with 7907 patients were assessed. The pooled result indicated that corticosteroids treatment could significantly reduce all-cause mortality in patients with COVID-19 (RR = 0.88, 95% CI [0.82, 0.95], P = 0.002). When subgroup analyses were performed, we found that corticosteroids were associated with decreased all-cause mortality in severe COVID-19 patients (RR = 0.77, 95% CI [0.68, 0.88], P < 0.0001), however no obvious difference was observed in all-cause mortality of non-severe COVID-19 patients between the corticosteroid and control group (RR = 0.96, 95% CI [0.86, 1.06], P = 0.41), meanwhile, a low dose (RR = 0.89, 95% CI [0.82, 0.97], P = 0.007) of dexamethasone (RR = 0.9, 95% CI [0.83, 0.98], P = 0.01) with a long treatment course (RR = 0.89, 95% CI [0.82, 0.98], P = 0.02) was beneficial for all-cause mortality in COVID-19 patients. Additionally, we found that corticosteroids might be associated with a longer length of hospital stay in non-severe COVID-19 patients (MD = 3.83, 95% CI [1.11, 6.56], P = 0.006).
Conclusion:
Our results showed that corticosteroid therapy was related to a reduction in all-cause mortality in severe COVID-19 patients. However, in patients with non-severe COVID-19, the use of corticosteroids did not decrease all-cause mortality and may prolong the duration of hospital stay. In addition, we revealed that a low dose of dexamethasone with a long treatment course could reduce all-cause mortality in COVID-19 patients.
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