COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

Treatment Tlayjeh H, Mhish OH, Enani MA, et al. Association of corticosteroids use and outcomes in COVID-19 patients: A systematic review and meta-analysis. J Infect Public Health. 2020 Nov;13(11):1652-1663. doi: 10.1016/j.jiph.2020.09.008. Epub 2020 Sep 29.
Abstract

BACKGROUND: To systematically review the literature about the association between systemic corticosteroid therapy (CST) and outcomes of COVID-19 patients.

METHODS: We searched Medline, Embase, EBM Reviews, Scopus, Web of Science, and preprints up to July 20, 2020. We included observational studies and randomized controlled trials (RCT) that assessed COVID-19 patients treated with CST. We pooled adjusted effect estimates of mortality and other outcomes using a random effect model, among studies at low or moderate risk for bias. We assessed the certainty of evidence for each outcome using the GRADE approach.

RESULTS: Out of 1067 citations screened for eligibility, one RCT and 19 cohort studies were included (16,977 hospitalized patients). Ten studies (1 RCT and 9 cohorts) with 10,278 patients examined the effect of CST on short term mortality. The pooled adjusted RR was 0.92 (95% CI 0.69-1.22, I2 = 81.94%). This effect was observed across all stages of disease severity. Four cohort studies examined the effect of CST on composite outcome of death, ICU admission and mechanical ventilation need. The pooled adjusted RR was 0.41(0.23-0.73, I2 = 78.69%). Six cohort studies examined the effect of CST on delayed viral clearance. The pooled adjusted RR was 1.47(95% CI 1.11-1.93, I2 = 43.38%).

CONCLUSION: In this systematic review, as of July 2020, heterogeneous and low certainty cumulative evidence based on observational studies and one RCT suggests that CST was not associated with reduction in short-term mortality but possibly with a delay in viral clearance in patients hospitalized with COVID-19 of different severities. However, the discordant results between the single RCT and observational studies as well as the heterogeneity observed across observational studies, call for caution in using observational data and suggests the need for more RCTs to identify the clinical and biochemical characteristics of patients' population that could benefit from CST.

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

Family Medicine (FM)/General Practice (GP) rater

Things change so quickly in the treatment of COVID, that newer information is likely to bump this result almost as soon as it is published.

Hospital Doctor/Hospitalists rater

These are more mixed findings on COVID-19 interventions. Steroids are certainly not a panacea or one-size-fits-all for patients with COVID-19 lung disease.

Infectious Disease rater

This is a well conducted systematic review and meta-analysis on the use of steroids for Covid-19. the methodology is correct, and the results somewhat different from those of other meta-analyses on the same topic (e.g., see the WHO paper in JAMA).

Intensivist/Critical Care rater

This information has been updated with more trial publications and a WHO meta-analysis. It's great work but out of date now. So, it is less relevant. P.S. I was involved with one of those trials.

Respirology/Pulmonology rater

I consider that it is methodologically impeccable work. The results obtained are indeterminate, showing that there is no firm evidence in this regard.