Corticosteroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials

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.

Figure 1

PRISMA diagram of search records and included studies.

Figure 2

Forest plot of subgroup comparisons of mortality rates. Pooled results were computed using restricted effects maximum likelihood with 95% confidence intervals (CIs) computed using the Q-profile method. A 95% prediction interval (PI) was also computed (see red bar). OR = odds ratio, SOC = standard of care.

Figure 3

Forest plot of subgroup comparisons of need for mechanical ventilation. Pooled results were computed using restricted effects maximum likelihood with 95% confidence intervals (CIs) computed using the Q-profile method. A 95% prediction interval (PI) was also computed (see red bar). OR = odds ratio, SOC = standard of care.

Figure 4

Forest plot of subgroup comparisons of serious adverse event rates. Pooled results were computed using restricted effects maximum likelihood with 95% confidence intervals (CIs) computed using the Q-profile method. OR = odds ratio, SOC = standard of care.

Figure 5

Forest plot of subgroup comparisons of superinfection rates. Pooled results were computed using restricted effects maximum likelihood with 95% confidence intervals (CIs) computed using the Q-profile method. OR = odds ratio, SOC = standard of care.