VolumeVol. 59 • Number No. 3 • July - September 2021 Back
Efficacy and Safety of Corticosteroid Administration in Moderate to Severe COVID-19: A Meta-analysis
Authors: Erika Xandra N. Talamayan, Alena Pias Bantolo, Clarissa M. Mendoza
DOI: 10.65564/pjim.10fd5ff5c7
Date of Publication: September 2021
Abstract
Background. Adding to the current available evidence on the efficacy of exogenous corticosteroids as an adjunct to standard of care in improving the clinical outcomes of COVID-19 patients. This meta-analysis examined the experimental and clinical data supporting this therapeutic intervention in improving clinical outcomes.
Objectives. This meta-analysis aimed to assess the efficacy of corticosteroids in improving outcomes in COVID-19 patients.
Search methods. Literature searches of electronic databases (PubMed, Cochrane Library, Science Direct, Google Scholar) were performed to identify relevant studies.
Data Collection and Analysis. Meta-analysis was performed using Review Manager (RevMan) software, version 5.4.1. Intervention effects were expressed in terms of mean differences and risk ratios for continuous and dichotomous variables, respectively. Fixed-effect or random-effects model was adopted according to heterogeneity.
Main Results. A total of seven studies were included in the quantitative synthesis. Analysis of pooled data showed a 12% reduced risk of mortality in COVID patients given corticosteroids (RR 0.88, 95% CI 0.81 to 0.95). Patients who were administered with corticosteroids also had 22% decreased risk of requiring invasive ventilation support (RR 0.78, 95% CI 0.64 to 0.95). Number of adverse events were similar between the two groups (RR 1.10, 95% CI 0.49 to 2.46).
Conclusion. Adjunct corticosteroid therapy provided improvements in clinical outcomes such as decreased deaths and decreased need for invasive ventilation support. There was no sufficient evidence of a significant adverse effect, hence it is relatively safe and beneficial to use in COVID19 patients.
Keywords. Corticosteroids, COVID-19, meta-analysis, clinical outcomes
References
- Villar J, Confalonier iM, Pastores SM, Meduri GU. Rationale for prolonged corticosteroid treatment in the acute respiratory distress syndrome caused by coronavirus disease 2019. Crit Care Explor. 2020; 2(4):e0111.
- Horby P,Lim WS, Emberson JR, et al; RECOVERY Collaborative Group. Dexamethasone in hospitalized patients with Covid-19—preliminary report. N Engl J Med. Published online July 17, 2020. doi:10.1056/NEJMoa2021436
- Dequin PF, Heming N, Meziani F, et al. Effect of hydrocortisone on 21-day mortality or respiratory support among critically ill patients with COVID-19: a randomized clinical trial. JAMA. Published online September 2, 2020. doi:10.1001/jama.2020.16761
- Tomazini BM,MaiaI S, Cavalcanti AB, et al. Effect of dexamethasone on days alive and ventilator-free in patients with moderate or severe acute respiratory distress syndrome and COVID-19: the CoDEX randomized clinical trial. JAMA. Published online September 2, 2020. doi:10.1001/jama.2020. 17021
- Jeronimo CMP, Farias MEL, Val FFA, et al. Methylprednisolone as adjunctive therapy for patients hospitalized with COVID-19 (Metcovid). Clin Infect Dis. Published online August 12, 2020. doi:10.1093/cid/ciaa1177
- Angus DC, Berry S, Lewis RJ, et al. Effect of Hydrocortisone on Mortality and Organ Support in patients with Severe Covid-19. The REMAP-CAP (Randomized Embedded Multifactorial Adaptive Platform for Community-acquired Pneumonia) study. Ann Am Thorac Soc. 2020;17(7):879-891.
- Guddino L, Bahamonde A, et al. GLUCOCOVID: A controlled trial of methylprednisolone in adults hospitalized with Covid-19 pneumonia.
- Solinas C, Perra L, Aiello M, Migliori E, Petrosillo N (2020). A critical evaluation of glucocorticoids in the management of severe COVID 19.
- Zhang W, Zhao Y, Zhang F, Wang Q, Li T, Liu Z, et al. The use of anti-inflammatory drugs in the treatment of people with severe coronavirus disease 2019 (COVID-19): The Perspectives of clinical immunologists from China. Clin Immunol. 2020; 214:108393-. 10.1016/j.clim.2020.108393 .
- Siddiqi HK, Mehra MR. COVID-19 Illness in Native and Immunosuppressed States: A Clinical-Therapeutic Staging Proposal. The Journal of Heart and Lung Transplantation. 10.1016/j.healun.2020.03.012
- Sanders JM, Monogue ML, Jodlowski TZ, Cutrell JB. Pharmacologic Treatments for Coronavirus Disease 2019 (COVID-19): A Review. JAMA. 2020. 10.1001/jama.2020.6019
- World Health Organization. Clinical management of severe acute respiratory infection (SARI) when COVID-19 disease is suspected.
- Arabi YM, Mandourah Y, Al-Hameed F, et al. Corticosteroid Therapy for Critically Ill Patients with Middle East Respiratory Syndrome. Am J Respir Crit Care Med 2018; 197(6): 757-67.
- Lee N, Allen Chan KC, Hui DS, et al. Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol 2004; 31(4): 304-9.
- Xiao JZ, Ma L, Gao J, et al. [Glucocorticoid-induced diabetes in severe acute respiratory syndrome: the impact of high dosage and duration of methylprednisolone therapy]. Zhonghua Nei Ke Za Zhi 2004; 43(3): 179-82.
- Bhimraj et al. Infectious Diseases Society of America Guidelines on the Treatment and Management of Patients with COVID-19. September 2020.
- Diaz et al. Corticosteroids for Covid 19. World Health Organization. September 2020
- Sterne et al. WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group. Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. September 2020