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COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Lu S, Zhou Q, Huang L, et al. Effectiveness and safety of glucocorticoids to treat COVID-19: a rapid review and meta-analysis. Ann Transl Med. 2020 May;8(10):627. doi: 10.21037/atm-20-3307.
Abstract

Background: Glucocorticoids are widely used in the treatment of various pulmonary inflammatory diseases, but they are also often accompanied by significant adverse reactions. Published guidelines point out that low dose and short duration systemic glucocorticoid therapy may be considered for patients with rapidly progressing coronavirus disease 2019 (COVID-19) while the evidence is still limited.

Methods: We comprehensively searched electronic databases and supplemented the screening by conducting a manual search. We included randomized controlled trials (RCTs) and cohort studies evaluating the effectiveness and safety of glucocorticoids in children and adults with COVID-19, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS), and conducted meta-analyses of the main indicators that were identified in the studies.

Results: Our search retrieved 23 studies, including one RCT and 22 cohort studies, with a total of 13,815 patients. In adults with COVID-19, the use of systemic glucocorticoid did not reduce mortality [risk ratio (RR) =2.00, 95% confidence interval (CI): 0.69 to 5.75, I2=90.9%] or the duration of lung inflammation [weighted mean difference (WMD) =-1 days, 95% CI: -2.91 to 0.91], while a significant reduction was found in the duration of fever (WMD =-3.23 days, 95% CI: -3.56 to -2.90). In patients with SARS, glucocorticoids also did not reduce the mortality (RR =1.52, 95% CI: 0.89 to 2.60, I2=84.6%), duration of fever (WMD =0.82 days, 95% CI: -2.88 to 4.52, I2=97.9%) or duration of lung inflammation absorption (WMD =0.95 days, 95% CI: -7.57 to 9.48, I2=94.6%). The use of systemic glucocorticoid therapy prolonged the duration of hospital stay in all patients (COVID-19, SARS and MERS).

Conclusions: Glucocorticoid therapy was found to reduce the duration of fever, but not mortality, duration of hospitalization or lung inflammation absorption. Long-term use of high-dose glucocorticoids increased the risk of adverse reactions such as coinfections, so routine use of systemic glucocorticoids for patients with COVID-19 cannot be recommend.

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

Emergency Medicine rater

This is a not a particularly well-done analysis. This meta-analysis actually covers use of glucocorticoid for several infectious diseases and then draws conclusion for COVID-19 and puts only that in the title. Recent RCT for COVID-19 showed benefit of glucocorticoids in severe COVID-19 with a relative reduction in death by one-third. I would not use this meta-analysis as the reference.

Intensivist/Critical Care rater

This is an interesting article in the setting of the other recent article related to Dexamethasone success in COVID-19. Which do we believe, the meta-analysis or the single successful trial?

Pediatric Emergency Medicine rater

This study assessed the utility and effectiveness of steroids in COVID-19 infection. This systematic analysis suggests that administration of steroids reduces the duration of fever, but did decrease mortality, duration of hospitalization or lung inflammation absorption. Furthermore it increases the risk of death particularly in patients with mild symptoms. This review provides an evidence against its routine use.