Efficacy and safety of systematic corticosteroids among severe COVID-19 patients : a systematic review and meta-analysis of randomized controlled trials

The benefits and harms of corticosteroids for patients with severe coronavirus disease 2019 (COVID-19) remain unclear. We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials from December 31, 2019 to October 1, 2020 to identify randomized controlled trials (RCTs) that evaluated corticosteroids in severe COVID-19 patients. The primary outcome was all-cause mortality at the longest follow-up. Secondary outcomes included a composite disease progression (progression to intubation, ventilation, extracorporeal membrane oxygenation, ICU transfer, or death among those not ventilated at enrollment) and incidence of serious adverse events. A random-effects model was applied to calculate risk ratio (RR) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development, and Evaluation approach to evaluate the certainty of the evidence. Seven RCTs involving 6250 patients were included, of which the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial comprised nearly 78% of all included subjects. Results showed that corticosteroids were associated with a decreased all-cause mortality (27.3 vs. 31.1%; RR: 0.85; 95% CI: 0.73-0.99; P = 0.04; low-certainty evidence). Trial sequential analysis suggested that more trials were still required to confirm the results. However, such survival benefit was absent if RECOVERY trial was excluded (RR: 0.83; 95% CI: 0.65-1.06; P = 0.13). Furthermore, corticosteroids decreased the occurrence of composite disease progression (30.6 vs. 33.3%; RR: 0.77; 95% CI: 0.64-0.92; P = 0.005), but not increased the incidence of serious adverse events (3.5 vs. 3.4%; RR: 1.16; 95% CI: 0.39-3.43; P = 0.79).

Media Type:

Electronic Article

Year of Publication:

2021

Contained In:

Signal transduction and targeted therapy - Vol. 6, No. 1 (2021), p. 83

Language:

English

Contributors:

Ma, Shaolei
Xu, Changsheng
Liu, Shijiang
Sun, Xiaodi
Li, Renqi
Mao, Mingjie
Feng, Shanwu
Wang, Xian

Links:

Volltext

Keywords:

Journal Article
Research Support, Non-U.S. Gov't
Review

Notes:

Date Revised 25.02.2021

published: Electronic

Citation Status In-Process

Copyright: From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

Physical Description:

Online-Ressource

doi:

10.1038/s41392-021-00521-7

PMID:

33612824

PPN (Catalogue-ID):

NLM322779723