Efficacy and Safety of Corticosteroid Use in Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Cui, Yuqing; Sun, Yali; Sun, Junyi; Liang, Huoyan; Ding, Xianfei; Sun, Xueyi; Wang, Dong; Sun, Tongwen

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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s40121-021-00518-3.