Work

Efficacy of corticosteroids in COVID-19: An evidence-based approach from the published randomized controlled trials

Year: 2024

Type: article

Study designs: Systematic Review, Meta-Analysis

Abstract: Background Despite a considerable volume of research on corticosteroid use in coronavirus disease-2019 (COVID-19), uncertainty and disagreements persist regarding their effectiveness. To address this, we conducted an umbrella review to consolidate the findings and performed an updated meta-analysis to strengthen the existing evidence. Methods Databases such as PubMed/MEDLINE, Cochrane library, SCOPUS and Embase were explored from the beginning to January 2024. Meta-analyses and randomized controlled trials (RCTs) assessing safety and efficacy of corticosteroids in COVID-19 patients were included. Methodological quality of included meta-analyses was evaluated using AMSTAR-2 checklist. Corrected covered area (CCA) was calculated to analyse the extent of overlap among primary studies. Cochrane risk of bias tool was used to assess the quality of included RCTs. Results Totally, 53 meta-analyses with low to critically low quality were included. Corticosteroid treatment was associated with better ventilator and intensive-care unit free days. A significant decrease in mortality was observed with dexamethasone, but not with any other steroids. There was slight (CCA = 3.67 %) degree of overlap of overall studies, but it was very high for RCTs (CCA = 16.5 %). Updated meta-analysis of 36 RCTs with 18,888 participants found corticosteroids to significantly reduce overall mortality (OR:0.85; 95%CI:0.76–0.95; p = 0.003). Similarly, dexamethasone (OR:0.86; 95%CI:0.76–0.97; p = 0.01) and low dose (≤80 mg) methylprednisolone (OR:0.85; 95%CI:0.76–0.95; p = 0.004) also significantly reduced mortality in COVID-19 patients. Risk of bias of included RCTs were low. Discussion There was very high overlap of RCTs among the included meta-analyses. Umbrella review demonstrated decreased mortality with dexamethasone. Updated meta-analysis confirmed mortality reduction with dexamethasone and low dose methylprednisolone in patients with COVID-19. Prospero registration CRD42021277160.

Source: Clinical Epidemiology and Global Health

DOI: 10.1016/j.cegh.2024.101867