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Inhaled corticosteroids on mortality in COVID-19: A systematic review and meta-analysis of randomized controlled

Fen Yang1, Guizuo Wang2, Dong Han2

  • 1Intensive Care Unit, Shaanxi Provincial People's Hospital, Xi'an, Shaanxi, China.

Journal of Investigative Medicine : the Official Publication of the American Federation for Clinical Research
|May 15, 2024
PubMed

Insights

Inhaled corticosteroids (ICS) did not significantly reduce mortality or the need for invasive ventilation in patients with coronavirus disease-2019 (COVID-19). This systematic review found no evidence supporting ICS use for improving COVID-19 outcomes.

Area of Science:

  • Pulmonology
  • Infectious Diseases
  • Clinical Trials

Background:

  • Coronavirus disease-2019 (COVID-19) is a significant global health concern.
  • Inhaled corticosteroids (ICS) are commonly used for respiratory conditions but their role in COVID-19 is unclear.
  • Understanding the impact of ICS on COVID-19 mortality is crucial for clinical management.

Purpose of the Study:

  • To systematically review and meta-analyze randomized controlled trials (RCTs) evaluating the efficacy of ICS in reducing mortality among COVID-19 patients.
  • To assess the effect of ICS on COVID-19-related death, all-cause death, and the requirement for invasive ventilation.

Main Methods:

  • A comprehensive systematic search was conducted across major databases including PubMed, Embase, Cochrane Library, and clinicaltrials.gov.
  • Eleven RCTs involving 5832 participants that investigated ICS treatment for COVID-19 were included.
  • Data were pooled using risk ratios (RRs) with 95% confidence intervals (CIs) to compare outcomes between groups.

Main Results:

  • No statistically significant difference was observed in COVID-19-related mortality (RR 0.88, 95% CI 0.38-2.04) between patients treated with ICS and control groups.
  • Similarly, no significant differences were found for all-cause mortality (RR 1.05, 95% CI 0.49-2.23) or the need for invasive ventilation (RR 1.26, 95% CI 0.60-2.62).

Conclusions:

  • Inhaled corticosteroids (ICS) are not associated with a reduction in mortality or invasive ventilation requirements in patients diagnosed with COVID-19.
  • Current evidence from RCTs does not support the use of ICS for improving clinical outcomes in COVID-19 patients.
  • Further research may be needed to explore potential specific subgroups or alternative mechanisms, but current findings advise against routine ICS use for COVID-19 mortality benefit.

Keywords:
COVID-19Mortalityinhaled corticosteroidsmeta-analysis

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