09.05.2020
Impact of corticosteroid therapy on outcomes of persons with SARS-CoV-2, SARS-CoV, or MERS-CoV infection: a systematic review and meta-analysis
Therapeutic Transversal
Li H et al
Leukemia
Main result
- The use of corticosteroids was associated with delayed viral clearance (2 studies, 81 subjects, no COVID-19:3.78 days, 95% CI1.16, 6.41 days)
- There was no reduction in mortality (8 studies, 3909 subjects), with similar results when separating severe and non-severe patients.
- Corticosteroids were associated with a longer duration of hospitalization (3 studies, 828 subjects)
- There was no evidence of an association between corticosteroids and mechanical ventilation, especially since the authors were unable to determine whether treatment was initiated before or after mechanical ventilation.
- No significant difference was found for the composite endpoint (death, resuscitation admission, mechanical ventilation) with similar results when separating severe and non-severe patients.
- Corticosteroids were more often used in severe patients compared to non-severe patients (4 studies of 4078 patients; no MERS)
Takeaways
Corticosteroid use was not associated with a statistically significant difference in mortality for patients with CA-MRSA-CoV, MERS-CoV, and COVID-19. With respect to the impact on viral clearance and duration of hospital stay, studies with COVID-19 were not analyzed.
No interpretation is possible with regard to corticosteroid therapy and the use of mechanical ventilation.
No interpretation is possible with regard to corticosteroid therapy and the use of mechanical ventilation.
Strength of evidence Moderate
Intermediary IF
Meta-analysis with a substantial number of participants but only one randomized clinical trial, publication bias, many criteria were evaluated for only 2 of the 3 pathologies studied, inclusion of severe and non-severe patients whereas the use of corticosteroids is mainly questioned for severe patients.
Objectives
Evaluate the efficacy of corticosteroids in patients with CoV-RASS, MERS-CoV and COVID-19
Method
Meta-analysis of 11 studies including 10 cohort studies and 1 randomized clinical trial including 5249 patients with MERS-CoV, SARS-CoV, or SARS-CoV-2, from 2003 to 2020, in China and Saudi Arabia.
Primary endpoints: viral clearance and death.
Secondary endpoints: duration of hospitalization, mechanical ventilation, composite endpoint (death, resuscitation admission, mechanical ventilation), use of corticosteroids in severe and non-severe patients.
Primary endpoints: viral clearance and death.
Secondary endpoints: duration of hospitalization, mechanical ventilation, composite endpoint (death, resuscitation admission, mechanical ventilation), use of corticosteroids in severe and non-severe patients.
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