ABSTRACT
Background: Corticosteroids are standard of care for moderate-to-severe COVID-19. However, the optimal dosing is unclear. Our objective was to compare higher dose corticosteroids to lower dose corticosteroids in patients with moderate-to-severe COVID-19. Method(s): We searched for randomized trials of adult patients with moderate-to-severe COVID-19 that compared corticosteroids versus placebo, standard care or that compared alternative doses of corticosteroids. We performed both a frequentist network and dose-response meta-analysis. We assessed risk of bias using a modified version of the Cochrane RoB 2.0 and used GRADE to assess the certainty of evidence. Result(s): We included 21 randomized trials with 9,640 patients. Our dose response analysis found that higher dose corticosteroids probably reduce mortality compared to lower dose (risk difference 13 fewer deaths per 1000 (95% CI 22.6 to 3.92 fewer);moderate certainty), may decrease the need of mechanical ventilation dose (risk difference 10 fewer per 1000 (95% CI 20.5 to 4.8 fewer) and probably decreases risk of infections (16.7 fewer infections per 1000 (95% CI 25 to 5.4 fewer);moderate certainty). Our network meta-analysis found that high dose corticosteroids probably reduce the duration of mechanical ventilation as compared to low dose (6.9 fewer days (95% CI 8.5 to 5.2 fewer);moderate certainty). The results of our network and dose response analysis were consistent. Conclusion(s): High dose corticosteroids is more effective than than low dose in reducing mortality.