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Higher versus Lower Dose Corticosteroids for Severe to Critical COVID-19: A Systematic Review and Dose-Response Meta-analysis.
Pitre, Tyler; Su, Johnny; Mah, Jasmine; Helmeczi, Wryan; Danhoe, Sharef; Plaxton, William; Giilck, Stephen; Rochwerg, Bram; Zeraatkar, Dena.
  • Pitre T; McMaster University, 3710, Hamilton, Ontario, Canada; tyler.pitre@medportal.ca.
  • Su J; McMaster University, 3710, Hamilton, Ontario, Canada.
  • Mah J; Dalhousie University, 3688, Halifax, Nova Scotia, Canada.
  • Helmeczi W; McMaster University, 3710, Hamilton, Ontario, Canada.
  • Danhoe S; McMaster University, 3710, Hamilton, Ontario, Canada.
  • Plaxton W; McMaster University, 3710, Hamilton, Ontario, Canada.
  • Giilck S; McMaster University, 3710, Hamilton, Ontario, Canada.
  • Rochwerg B; McMaster University, 3710, Hamilton, Ontario, Canada.
  • Zeraatkar D; Harvard University, 1812, Cambridge, Massachusetts, United States.
Ann Am Thorac Soc ; 2022 Nov 30.
Article in English | MEDLINE | ID: covidwho-2276595
ABSTRACT
RATIONALE Corticosteroids are standard of care for patients with severe COVID-19. However, the optimal dose is uncertain.

OBJECTIVE:

To compare higher doses of corticosteroids with lower doses in patients with COVID-19.

METHODS:

We searched MEDLINE, Embase, Cochrane Central Register of Controlled Trials, MedRxiv, and Web of Science from inception to August 1st, 2022, for trials that randomized patients with severe-to-critical COVID-19 to corticosteroids, standard care, or placebo. Reviewers, working in duplicate, screened references, extracted data, and assessed risk of bias using a modified version of the Cochrane risk of bias 2.0 tool. We performed a dose-response meta-analysis and used the GRADE framework to assess the certainty of evidence. We present our results both in relative risk and absolute risk difference (RD) per 1000 with 95% confidence intervals (CI).

RESULTS:

We included 20 trials, with 10,155 patients. We show that, compared to lower-dose corticosteroids, higher-dose corticosteroids probably reduce mortality (RD 14 fewer deaths per 1000 [95% CI 26 to 2 fewer]; moderate certainty) and may reduce the need for mechanical ventilation (RD 11.6 fewer per 1000 [95% CI 23.2 fewer to 6.9 more]; low certainty). The effect of corticosteroids on nosocomial infections is uncertain (16.7 fewer infections per 1000 [95% CI 5.4 to 25.0 fewer]; very low certainty).

CONCLUSIONS:

Relatively higher doses of corticosteroids may be beneficial in patients with severe-to-critical COVID-19 and may not increase the risk of nosocomial infections. .

Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Language: English Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Type of study: Experimental Studies / Prognostic study / Randomized controlled trials / Reviews / Systematic review/Meta Analysis Language: English Year: 2022 Document Type: Article