COVID-19 Evidence Alerts
from McMaster PLUSTM

Current best evidence for clinical care (more info)

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Treatment Pulakurthi YS, Pederson JM, Saravu K, et al. Corticosteroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials. Medicine (Baltimore). 2021 May 21;100(20):e25719. doi: 10.1097/MD.0000000000025719.
Abstract

BACKGROUND: Corticosteroid treatment is an effective and common therapeutic strategy for various inflammatory lung pathologies and may be an effective treatment for coronavirus disease 2019 (COVID-19). The purpose of this systematic review and meta-analysis of current literature was to investigate the clinical outcomes associated with corticosteroid treatment of COVID-19.

METHODS: We systematically searched PubMed, medRxiv, Web of Science, and Scopus databases through March 10, 2021 to identify randomized controlled trials (RCTs) that evaluated the effects of corticosteroid therapies for COVID-19 treatment. Outcomes of interest were mortality, need for mechanical ventilation, serious adverse events (SAEs), and superinfection.

RESULTS: A total of 7737 patients from 8 RCTs were included in the quantitative meta-analysis, of which 2795 (36.1%) patients received corticosteroids plus standard of care (SOC) while 4942 (63.9%) patients received placebo and/or SOC alone. The odds of mortality were significantly lower in patients that received corticosteroids as compared to SOC (odds ratio [OR]?=?0.85 [95% CI: 0.76; 0.95], P?=?.003). Corticosteroid treatment reduced the odds of a need for mechanical ventilation as compared to SOC (OR?=?0.76 [95% CI: 0.59; 0.97], P?=?.030). There was no significant difference between the corticosteroid and SOC groups with regards to SAEs and superinfections.

CONCLUSION: Corticosteroid treatment can reduce the odds for mortality and the need for mechanical ventilation in severe COVID-19 patients.

Ratings
Discipline / Specialty Area Score
Emergency Medicine
Hospital Doctor/Hospitalists
Internal Medicine
Infectious Disease
Intensivist/Critical Care
Comments from MORE raters

Emergency Medicine rater

One very large trial contributes most of the effect. The CIs are VERY close to 1.

Emergency Medicine rater

As an Internist working at a COVID-19 clinic, I found this information very useful for my every day clinical practice.

Intensivist/Critical Care rater

This meta-analysis of corticosteroids in COVID-19 is consistent with other meta-analyses in this area, despite using slightly different group of RCTs. All of this is driven by RECOVERY RCT so any meta-analysis that includes RECOVERY, as this one does, is going to find similar results. I don't think these results are all that novel.