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COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Li H, Chen C, Hu F, et al. Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis. Leukemia. 2020 Jun;34(6):1503-1511. doi: 10.1038/s41375-020-0848-3. Epub 2020 May 5.
Abstract

We performed a meta-analysis to determine safety and efficacy of corticosteroids in SARS-CoV-2, SARS-CoV, and MERS-CoV infections. We searched PubMed, Web of Science, Medline, WanFang Chinese database, and ZhiWang Chinese database using Boolean operators and search terms covering SARS-CoV-2, SARS-CoV, OR MERS-CoV AND corticosteroids to find appropriate studies. Review Manager 5.3 was used to analyze results of meta-analysis. Observational studies were analyzed for quality using the modified Newcastle-Ottawa scale and randomized clinical trials, using the Jadad scale. Subjects were divided into those with severe-only and other (severe and not severe) cohorts based on published criteria. Efficacy endpoints studied included mortality, hospitalization duration, rates of intensive care unit (ICU) admission, use of mechanical ventilation, and a composite endpoint (death, ICU admission, or mechanical ventilation). We included 11 reports including 10 cohort studies and 1 randomized clinical trial involving 5249 subjects (2003-2020). Two discussed the association of corticosteroids and virus clearing and 10 explored how corticosteroids impacted mortality, hospitalization duration, use of mechanical ventilation, and a composite endpoint. Corticosteroid use was associated with delayed virus clearing with a mean difference (MD) = 3.78 days (95% confidence Interval [CI] = 1.16, 6.41 days; I2 = 0%). There was no significant reduction in deaths with relative Risk Ratio (RR) = 1.07 (90% CI = 0.81; 1.42; I2 = 80%). Hospitalization duration was prolonged and use of mechanical ventilation increased. In conclusion, corticosteroid use in subjects with SARS-CoV-2, SARS-CoV, and MERS-CoV infections delayed virus clearing and did not convincingly improve survival, reduce hospitalization duration or ICU admission rate and/or use of mechanical ventilation. There were several adverse effects. Because of a preponderance of observational studies in the dataset and selection and publication biases our conclusions, especially regarding SARS-CoV-2, need confirmation in a randomized clinical trial. In the interim we suggest caution using corticosteroids in persons with COVID-19.

Ratings
Discipline / Specialty Area Score
Hospital Doctor/Hospitalists
Internal Medicine
Family Medicine (FM)/General Practice (GP)
General Internal Medicine-Primary Care(US)
Intensivist/Critical Care
Respirology/Pulmonology
Emergency Medicine
Infectious Disease
Comments from MORE raters

Emergency Medicine rater

This is nothing really new and the reports from China not included in the meta-analysis confirm the results. Steroids in ARDS are controversial of itself and this makes me, a steroid non-believer in ARDS, even more resolute.

Emergency Medicine rater

This is a generally well-designed and executed meta-analysis on the effect of corticosteroids in all serious coronavirus infections (SARS, MERS, COVID-19). Only 1 randomized trial was found. All results point to steroids being unhelpful, and unless better evidence becomes available, they should be avoided in treating presumed/confirmed cases of COVID-19.

General Internal Medicine-Primary Care(US) rater

This article summarizes the information we have so far on the use of steroids in the treatment of these novel viruses. While the data are not robust and many readers may already know this, it is certainly timely.

General Internal Medicine-Primary Care(US) rater

In metanalysis, one kind of information is gained and one kind is lost. I believe we continue to miss a critical dimension in contagion: infectivity and severity. Corticosteroid use often has the most interesting and enigmatic findings.

Hospital Doctor/Hospitalists rater

There is a plethora of new information on COVID-19 being released, much of it with poor methodology or conflicting results. Insightful but measured analysis of the existing literature is needed, and these authors have done a good job summarizing existing findings and important limitations with existing work.

Hospital Doctor/Hospitalists rater

A very important article in the current situation. This article clearly highlights that steroids are not effective in treatment of COVID and actually are detrimental with poorer outcomes.

Respirology/Pulmonology rater

Conclusions of such studies should be better sustained: isn't it too early for them?