Effects of different corticosteroid therapy on severe COVID-19 patients: a meta-analysis of randomized controlled trials.

ABSTRACT

BACKGROUND: To assess the efficacy and safety of corticosteroids in COVID-19 patients compared with standard care or placebo. METHODS: Electronic databases were searched to identify relevant studies. The mortality, adverse events, and other data from studies were pooled for statistical analysis. RESULTS: Ten randomized clinical trials were eligible for inclusion. Corticosteroid treatment in COVID-19 patients did not significantly reduce the risk of death (RR 0.93; CI 0.82, 1.05) and the need for mechanical ventilation (RR 0.82; CI 0.62, 1.08). No mortality reduction was also observed in the subgroup of patients requiring mechanical ventilation (RR 0.90; CI 0.79-1.03). The use of corticosteroids increased mortality in the subgroup of patients not requiring oxygen support (RR 1.24; CI 1.00-1.55). The survival benefit was observed in a low dosage of corticosteroids (RR 0.90; CI 0.84-0.97) and dexamethasone (RR 0.90; 95% CI 0.79-1.04). There was no difference in the rates of adverse events (RR 1.13; CI 0.58, 2.20) and secondary infections (RR 0.87; CI 0.66, 1.15). CONCLUSION: Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. Low-dose dexamethasone could be considered as a drug for the treatment of COVID-19 patients. More high-quality trials are needed to further verify this conclusion.Expert Opinion The effect of corticosteroids on patient survival highly depended on the selection of the right dosage and type and in a specific subgroup of patients. This meta-analysis, which included more RCTs, evaluated the safety and efficacy in severe COVID-19 patients and analyzed the effects of different types of corticosteroid treatments. Corticosteroid treatment did not convincingly improve survival in severe COVID-19 patients. But the low dose dexamethasone appear to have a role in the management of severe COVID-19 patients.