Abstract
ObjectivesCoronavirus disease 2019 (COVID-19) remains a global challenge. Corticosteroids constitute a group of anti-inflammatory and immunosuppressive drugs that are widely used in the treatment of COVID-19. Comprehensive reviews investigating the comparative proportion and efficacy of corticosteroid use are scarce. Therefore, we conducted a systematic review and meta-analysis of clinical trials to evaluate the proportion and efficacy of corticosteroid use for the treatment of COVID-19.MethodsWe conducted a comprehensive literature review and meta-analysis of research articles, including observational studies and clinical trials, by searching the PubMed, EMBASE, Cochrane Controlled Trials Registry, and China Academic Journal Network Publishing databases. Patients treated between December 1, 2019, and January 1, 2021, were included. The outcome measures were the proportion of patients treated with corticosteroids, viral clearance and mortality. The effect size with the associated 95% confidence interval is reported as the weighted mean difference for continuous outcomes and the odds ratio for dichotomous outcomes.ResultsFifty-two trials involving 15710 patients were included. The meta-analysis demonstrated that the proportion of COVID-19 patients who received corticosteroids was significantly lower than that of patients who did not receive corticosteroids (35.19% vs. 64.49%). In addition, our meta-analysis demonstrated no significant difference in the proportions of severe and nonsevere cases treated with corticosteroids (27.91% vs. 20.91%). We also performed subgroup analyses stratified by whether patients stayed in the intensive care unit (ICU) and found that the proportion of patients who received corticosteroids was significantly higher among those who stayed in the ICU than among those who did not. The results of our meta-analysis indicate that corticosteroid treatment significantly delayed the viral clearance time. Finally, our meta-analysis demonstrated no significant difference in the use of corticosteroids for COVID-19 between patients who died and those who survived. This result indicates that mortality is not correlated with corticosteroid therapy.ConclusionThe proportion of COVID-19 patients who received corticosteroids was significantly lower than that of patients who did not receive corticosteroids. Corticosteroid use in subjects with severe acute respiratory syndrome coronavirus 2 infections delayed viral clearance and did not convincingly improve survival; therefore, corticosteroids should be used with extreme caution in the treatment of COVID-19.
Highlights
Coronavirus disease 2019 (COVID-19) is a novel viral respiratory disease that surfaced in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), a novel, highly diverse, enveloped, positive single-stranded betacoronavirus that belongs to the subgenus Sarbecovirus [1]
Corticosteroid use in subjects with severe acute respiratory syndrome coronavirus 2 infections delayed viral clearance and did not convincingly improve survival; corticosteroids should be used with extreme caution in the treatment of COVID-19
extracorporeal membrane oxygenation (ECMO) plays a role in the stabilization and survival of select critically ill patients with severe pulmonary and cardiac compromise; determining whether ECMO supplemented with corticosteroids is useful for improving the survival rate still requires more research
Summary
Coronavirus disease 2019 (COVID-19) is a novel viral respiratory disease that surfaced in December 2019 and is caused by severe acute respiratory syndrome coronavirus 2 (SARSCoV-2), a novel, highly diverse, enveloped, positive single-stranded betacoronavirus that belongs to the subgenus Sarbecovirus [1]. The rapid progression of the COVID-19 pandemic has become a global concern. By March 11, 2020, Central European Time, 114 countries had become involved, 118319 laboratory-confirmed infections had been reported, over 4000 deaths had occurred, and the World Health Organization (WHO) declared the COVID-19 outbreak a global pandemic [2]. The pathogenesis of viral pneumonia may not be virus-induced cytopathy but rather an aberrant host immune reaction (e.g., cytokine storm) to the viral infection in all affected patients [5]. Because the immune pathogenesis of pneumonia may be the same in all infected patients, the timing of immunomodulator (corticosteroid) treatment is crucial, and the early control of initial immune-mediated lung injury is helpful for reducing patient morbidity and possible mortality [5]. Corticosteroids do not directly inhibit virus replication, and their main role is inhibiting inflammation and suppressing the immune response [6]
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