Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis
Introduction We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in patients with COVID-19. Methods The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed random...
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| Veröffentlicht in: | Infectious diseases and therapy 2021-12, Vol.10 (4), p.2447-2463 |
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| creator | Cui, Yuqing Sun, Yali Sun, Junyi Liang, Huoyan Ding, Xianfei Sun, Xueyi Wang, Dong Sun, Tongwen |
| description | Introduction
We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in patients with COVID-19.
Methods
The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OSs) that examined corticosteroid use in patients with COVID-19. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events.
Results
A total of 11 RCTs and 44 OSs involving 7893 and 41,164 patients with COVID-19 were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR 0.91, 95% CI 0.77–1.07;
I
2
= 63.4%). The subgroup analysis of pulse dose corticosteroid showed survival benefit statistically (OR 0.29, 95% CI 0.15–0.56). Moreover, the corticosteroid use may reduce the need for MV (OR 0.67, 95% CI 0.51–0.90;
I
2
= 7.5%) with no significant increase in serious adverse reactions (OR 0.84, 95% CI 0.30–2.37;
I
2
= 33.3%). In addition, the included OSs showed that the pulse dose (OR 0.66, 95% CI 0.45–0.95;
I
2
= 30.8%) might lower the mortality in patients with COVID-19. The pulse dose of methylprednisolone (OR 0.60, 95% CI 0.45–0.80;
I
2
= 0%) had a beneficial effect on survival. It was especially significant when the duration of pulse methylprednisolone use was less than 7 days (OR 0.59, 95% CI 0.43–0.80;
I
2
= 0%).
Conclusions
This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in patients with COVID-19 and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone for less than 7 days may be a good treatment choice for patients with COVID-19. |
| doi_str_mv | 10.1007/s40121-021-00518-3 |
| format | Article |
| fullrecord | <record><control><sourceid>gale_pubme</sourceid><recordid>TN_cdi_pubmedcentral_primary_oai_pubmedcentral_nih_gov_8363240</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><galeid>A681599803</galeid><sourcerecordid>A681599803</sourcerecordid><originalsourceid>FETCH-LOGICAL-c584t-debff2e22079f40645e19d110604bdc8212fe01c3f087e6ebf87aee889bf88fd3</originalsourceid><addsrcrecordid>eNp9kl1rFDEUhoMotqz9A14FvKkXU_M1M4kXwrKtWqgUrPU2ZDMna8psUpOZLfPvzbiLWhEJhxxOnvdNDjkIvaTkjBLSvsmCUEYrMgepqaz4E3TMqOJVwyV7esglY-oIneR8R0jhpaCqfY6OuOBSqZYco4cL57w1dsImdPjGOBgmHB1exTR4G_MAKfoO32bAPszVGMzOpzHjc5_BlDIjVOHT1fXXy_OKqtdv8RLfTEW3NcUAf4adh4ef5p9gMNUymH7KPr9Az5zpM5wc9gW6fX_xZfWxurr-cLlaXlW2lmKoOlg7x4Ax0ionSCNqoKqjlDRErDsrGWUOCLXcEdlCU2jZGgApVcmk6_gCvdv73o_rLXQWwpBMr--T35o06Wi8fnwS_De9iTstecOZIMXg9GCQ4vcR8qC3PlvoexMgjlmzuqFCNqLgC_TqL_Qujqk0XCjZtOW7-J_UxvSgfXCx3GtnU71sJK2VkoQX6uwfVFkdbMu_BHC-1B8J2F5gU8w5gfvVIyV6nhi9nxhN5pgnRs8ivhflAocNpN8v_o_qB_X3vzs</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2867121336</pqid></control><display><type>article</type><title>Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis</title><source>PubMed Central(OpenAccess)</source><source>SpringerOpen website</source><source>Directory of Open Access Journals</source><source>EZB Electronic Journals Library</source><creator>Cui, Yuqing ; Sun, Yali ; Sun, Junyi ; Liang, Huoyan ; Ding, Xianfei ; Sun, Xueyi ; Wang, Dong ; Sun, Tongwen</creator><creatorcontrib>Cui, Yuqing ; Sun, Yali ; Sun, Junyi ; Liang, Huoyan ; Ding, Xianfei ; Sun, Xueyi ; Wang, Dong ; Sun, Tongwen</creatorcontrib><description>Introduction
We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in patients with COVID-19.
Methods
The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OSs) that examined corticosteroid use in patients with COVID-19. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events.
Results
A total of 11 RCTs and 44 OSs involving 7893 and 41,164 patients with COVID-19 were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR 0.91, 95% CI 0.77–1.07;
I
2
= 63.4%). The subgroup analysis of pulse dose corticosteroid showed survival benefit statistically (OR 0.29, 95% CI 0.15–0.56). Moreover, the corticosteroid use may reduce the need for MV (OR 0.67, 95% CI 0.51–0.90;
I
2
= 7.5%) with no significant increase in serious adverse reactions (OR 0.84, 95% CI 0.30–2.37;
I
2
= 33.3%). In addition, the included OSs showed that the pulse dose (OR 0.66, 95% CI 0.45–0.95;
I
2
= 30.8%) might lower the mortality in patients with COVID-19. The pulse dose of methylprednisolone (OR 0.60, 95% CI 0.45–0.80;
I
2
= 0%) had a beneficial effect on survival. It was especially significant when the duration of pulse methylprednisolone use was less than 7 days (OR 0.59, 95% CI 0.43–0.80;
I
2
= 0%).
Conclusions
This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in patients with COVID-19 and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone for less than 7 days may be a good treatment choice for patients with COVID-19.</description><identifier>ISSN: 2193-8229</identifier><identifier>EISSN: 2193-6382</identifier><identifier>DOI: 10.1007/s40121-021-00518-3</identifier><identifier>PMID: 34389970</identifier><language>eng</language><publisher>Cheshire: Springer Healthcare</publisher><subject>Analysis ; Complications and side effects ; Coronaviruses ; Corticosteroids ; COVID-19 ; Infectious Diseases ; Internal Medicine ; Literature reviews ; Medicine ; Medicine & Public Health ; Meta-analysis ; Methylprednisolone ; Mortality ; Observational studies ; Original Research ; Steroids ; Wang, Dong</subject><ispartof>Infectious diseases and therapy, 2021-12, Vol.10 (4), p.2447-2463</ispartof><rights>The Author(s) 2021</rights><rights>COPYRIGHT 2021 Springer</rights><rights>The Author(s) 2021. This work is published under http://creativecommons.org/licenses/by-nc/4.0/ (the “License”). Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c584t-debff2e22079f40645e19d110604bdc8212fe01c3f087e6ebf87aee889bf88fd3</citedby><cites>FETCH-LOGICAL-c584t-debff2e22079f40645e19d110604bdc8212fe01c3f087e6ebf87aee889bf88fd3</cites><orcidid>0000-0001-6536-3222</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363240/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC8363240/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,27924,27925,41120,42189,51576,53791,53793</link.rule.ids></links><search><creatorcontrib>Cui, Yuqing</creatorcontrib><creatorcontrib>Sun, Yali</creatorcontrib><creatorcontrib>Sun, Junyi</creatorcontrib><creatorcontrib>Liang, Huoyan</creatorcontrib><creatorcontrib>Ding, Xianfei</creatorcontrib><creatorcontrib>Sun, Xueyi</creatorcontrib><creatorcontrib>Wang, Dong</creatorcontrib><creatorcontrib>Sun, Tongwen</creatorcontrib><title>Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis</title><title>Infectious diseases and therapy</title><addtitle>Infect Dis Ther</addtitle><description>Introduction
We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in patients with COVID-19.
Methods
The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OSs) that examined corticosteroid use in patients with COVID-19. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events.
Results
A total of 11 RCTs and 44 OSs involving 7893 and 41,164 patients with COVID-19 were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR 0.91, 95% CI 0.77–1.07;
I
2
= 63.4%). The subgroup analysis of pulse dose corticosteroid showed survival benefit statistically (OR 0.29, 95% CI 0.15–0.56). Moreover, the corticosteroid use may reduce the need for MV (OR 0.67, 95% CI 0.51–0.90;
I
2
= 7.5%) with no significant increase in serious adverse reactions (OR 0.84, 95% CI 0.30–2.37;
I
2
= 33.3%). In addition, the included OSs showed that the pulse dose (OR 0.66, 95% CI 0.45–0.95;
I
2
= 30.8%) might lower the mortality in patients with COVID-19. The pulse dose of methylprednisolone (OR 0.60, 95% CI 0.45–0.80;
I
2
= 0%) had a beneficial effect on survival. It was especially significant when the duration of pulse methylprednisolone use was less than 7 days (OR 0.59, 95% CI 0.43–0.80;
I
2
= 0%).
Conclusions
This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in patients with COVID-19 and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone for less than 7 days may be a good treatment choice for patients with COVID-19.</description><subject>Analysis</subject><subject>Complications and side effects</subject><subject>Coronaviruses</subject><subject>Corticosteroids</subject><subject>COVID-19</subject><subject>Infectious Diseases</subject><subject>Internal Medicine</subject><subject>Literature reviews</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Methylprednisolone</subject><subject>Mortality</subject><subject>Observational studies</subject><subject>Original Research</subject><subject>Steroids</subject><subject>Wang, Dong</subject><issn>2193-8229</issn><issn>2193-6382</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>C6C</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>AZQEC</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><sourceid>DWQXO</sourceid><recordid>eNp9kl1rFDEUhoMotqz9A14FvKkXU_M1M4kXwrKtWqgUrPU2ZDMna8psUpOZLfPvzbiLWhEJhxxOnvdNDjkIvaTkjBLSvsmCUEYrMgepqaz4E3TMqOJVwyV7esglY-oIneR8R0jhpaCqfY6OuOBSqZYco4cL57w1dsImdPjGOBgmHB1exTR4G_MAKfoO32bAPszVGMzOpzHjc5_BlDIjVOHT1fXXy_OKqtdv8RLfTEW3NcUAf4adh4ef5p9gMNUymH7KPr9Az5zpM5wc9gW6fX_xZfWxurr-cLlaXlW2lmKoOlg7x4Ax0ionSCNqoKqjlDRErDsrGWUOCLXcEdlCU2jZGgApVcmk6_gCvdv73o_rLXQWwpBMr--T35o06Wi8fnwS_De9iTstecOZIMXg9GCQ4vcR8qC3PlvoexMgjlmzuqFCNqLgC_TqL_Qujqk0XCjZtOW7-J_UxvSgfXCx3GtnU71sJK2VkoQX6uwfVFkdbMu_BHC-1B8J2F5gU8w5gfvVIyV6nhi9nxhN5pgnRs8ivhflAocNpN8v_o_qB_X3vzs</recordid><startdate>20211201</startdate><enddate>20211201</enddate><creator>Cui, Yuqing</creator><creator>Sun, Yali</creator><creator>Sun, Junyi</creator><creator>Liang, Huoyan</creator><creator>Ding, Xianfei</creator><creator>Sun, Xueyi</creator><creator>Wang, Dong</creator><creator>Sun, Tongwen</creator><general>Springer Healthcare</general><general>Springer</general><general>Springer Nature B.V</general><scope>C6C</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8AO</scope><scope>8C1</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>AZQEC</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>COVID</scope><scope>DWQXO</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PIMPY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><scope>5PM</scope><orcidid>https://orcid.org/0000-0001-6536-3222</orcidid></search><sort><creationdate>20211201</creationdate><title>Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis</title><author>Cui, Yuqing ; Sun, Yali ; Sun, Junyi ; Liang, Huoyan ; Ding, Xianfei ; Sun, Xueyi ; Wang, Dong ; Sun, Tongwen</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c584t-debff2e22079f40645e19d110604bdc8212fe01c3f087e6ebf87aee889bf88fd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Analysis</topic><topic>Complications and side effects</topic><topic>Coronaviruses</topic><topic>Corticosteroids</topic><topic>COVID-19</topic><topic>Infectious Diseases</topic><topic>Internal Medicine</topic><topic>Literature reviews</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Methylprednisolone</topic><topic>Mortality</topic><topic>Observational studies</topic><topic>Original Research</topic><topic>Steroids</topic><topic>Wang, Dong</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Cui, Yuqing</creatorcontrib><creatorcontrib>Sun, Yali</creatorcontrib><creatorcontrib>Sun, Junyi</creatorcontrib><creatorcontrib>Liang, Huoyan</creatorcontrib><creatorcontrib>Ding, Xianfei</creatorcontrib><creatorcontrib>Sun, Xueyi</creatorcontrib><creatorcontrib>Wang, Dong</creatorcontrib><creatorcontrib>Sun, Tongwen</creatorcontrib><collection>SpringerOpen website</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>ProQuest Nursing and Allied Health Journals</collection><collection>ProQuest - Health & Medical Complete保健、医学与药学数据库</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>ProQuest Pharma Collection</collection><collection>Public Health Database (Proquest)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni)</collection><collection>ProQuest Central</collection><collection>ProQuest Central Essentials</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Coronavirus Research Database</collection><collection>ProQuest Central</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>Publicly Available Content Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><collection>PubMed Central (Full Participant titles)</collection><jtitle>Infectious diseases and therapy</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Cui, Yuqing</au><au>Sun, Yali</au><au>Sun, Junyi</au><au>Liang, Huoyan</au><au>Ding, Xianfei</au><au>Sun, Xueyi</au><au>Wang, Dong</au><au>Sun, Tongwen</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis</atitle><jtitle>Infectious diseases and therapy</jtitle><stitle>Infect Dis Ther</stitle><date>2021-12-01</date><risdate>2021</risdate><volume>10</volume><issue>4</issue><spage>2447</spage><epage>2463</epage><pages>2447-2463</pages><issn>2193-8229</issn><eissn>2193-6382</eissn><abstract>Introduction
We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in patients with COVID-19.
Methods
The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OSs) that examined corticosteroid use in patients with COVID-19. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events.
Results
A total of 11 RCTs and 44 OSs involving 7893 and 41,164 patients with COVID-19 were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR 0.91, 95% CI 0.77–1.07;
I
2
= 63.4%). The subgroup analysis of pulse dose corticosteroid showed survival benefit statistically (OR 0.29, 95% CI 0.15–0.56). Moreover, the corticosteroid use may reduce the need for MV (OR 0.67, 95% CI 0.51–0.90;
I
2
= 7.5%) with no significant increase in serious adverse reactions (OR 0.84, 95% CI 0.30–2.37;
I
2
= 33.3%). In addition, the included OSs showed that the pulse dose (OR 0.66, 95% CI 0.45–0.95;
I
2
= 30.8%) might lower the mortality in patients with COVID-19. The pulse dose of methylprednisolone (OR 0.60, 95% CI 0.45–0.80;
I
2
= 0%) had a beneficial effect on survival. It was especially significant when the duration of pulse methylprednisolone use was less than 7 days (OR 0.59, 95% CI 0.43–0.80;
I
2
= 0%).
Conclusions
This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in patients with COVID-19 and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone for less than 7 days may be a good treatment choice for patients with COVID-19.</abstract><cop>Cheshire</cop><pub>Springer Healthcare</pub><pmid>34389970</pmid><doi>10.1007/s40121-021-00518-3</doi><tpages>17</tpages><orcidid>https://orcid.org/0000-0001-6536-3222</orcidid><oa>free_for_read</oa></addata></record> |
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| source | PubMed Central(OpenAccess); SpringerOpen website; Directory of Open Access Journals; EZB Electronic Journals Library |
| subjects | Analysis Complications and side effects Coronaviruses Corticosteroids COVID-19 Infectious Diseases Internal Medicine Literature reviews Medicine Medicine & Public Health Meta-analysis Methylprednisolone Mortality Observational studies Original Research Steroids Wang, Dong |
| title | Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis |
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