Current best evidence for clinical care (more info)
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.
|Discipline / Specialty Area||Score|
One very large trial contributes most of the effect. The CIs are VERY close to 1.
As an Internist working at a COVID-19 clinic, I found this information very useful for my every day clinical practice.
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.