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

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 metaanalysis 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. Abbreviations: ARDS = acute respiratory distress syndrome, COVID-19 = coronavirus disease 2019, ICU = intensive care unit, OR = odds ratio, RCT = randomized controlled trial, SAE = serious adverse event, SARS-CoV = severe acute respiratory syndrome coronavirus, SOC = standard of care.