Effectiveness and Safety of Glucocorticoids to Treat COVID-19: A Rapid Review and Meta-Analysis

Shuya Lu; Qi Zhou; Liping Huang; Qianling Shi; Siya Zhao; Zijun Wang; Weiguo Li; Yuyi Tang; Yanfang Ma; Xufei Luo; Toshio Fukuoka; Hyeong Sik Ahn; Myeong Soo Lee; Zhengxiu Luo; Enmei Liu; Yaolong Chen; Chenyan Zhou; Donghong Peng

The copyright holder for this preprint (which was not peer-reviewed) is the . https://doi.org /10.1101/2020.04.17.20064469 doi: medRxiv preprint one on severe MERS) (29-41) with a total of 11,211 patients. The use of systemic glucocorticoid did not reduce the risk of death in COVID-19 (RR=2.0, 95% CI: 0.7 to 5.8, I²=90.9%) or SARS patients (RR=1.5, 95% CI: 0.9 to 2.6, I²=84.6%). Subgroup analyses showed that glucocorticoids also did not reduce the risk of death in severe cases of SARS (RR=1.3, 95% CI: 0.5 to 3.3, I²=67.4%) or in adults (RR=1.1, 95% CI: 0.7 to 1.8, I²=68.7%). In mild cases of SARS glucocorticoids even increased the risk of death (RR=3.6, 95% CI: 1.9 to 6.9). In adult patients with MERS, the use of glucocorticoid increased mortality (RR=1.3, 95% CI: 1.1 to 1.5) ( Five cohort studies with a total of 4709 patients assessed the duration of fever in COVID-19 (one study) and SARS (four studies) patients (30, 32, 35, 40, 42) . The duration of fever was significantly lower in COVID-19 patients who received glucocorticoid treatment than in patients who received no glucocorticoid treatment (WMD=-3.2 d, 95% CI: -3.6 to -2.9), while for SARS patients there was no difference (WMD=0.8 d, 95% CI: -2.9 to 4.5, I²=97.9%). Subgroup analysis showed that glucocorticoid use did not shorten the duration of fever neither in patients with severe SARS (WMD=-1.1 d, 95% CI: -4.9 to 2.7, I²=58.3%) nor in patients with mild SARS (WMD=0.5 d, 95% CI: -4.2 to 5.1, I²=95.1%) ( Figure 5, Figure 6 ).