Corticosteroids decreased the risk of mortality in patients with severe COVID-19 infection but were associated with a longer hospital stays among those with nonsevere disease, according to results of a meta-analysis published in Medicina Clinica.
Researchers searched PubMed, Embase, and Cochrane Library for randomized controlled studies (RCTs) that adults hospitalized with severe and nonsevere COVID-19 infection. Outcomes were compared between patients treated with or without (controls) corticosteroids. The primary endpoint was all-cause mortality. Additional subgroup analyses were performed on the basis of COVID-19 disease severity, as well as corticosteroid dosage, type, and treatment time. The secondary endpoint was length of hospitalization.
There were 9 RCTs comprising 7907 patients included in the analysis. Of these patients, 2940 received vs 4967 in the control group.
All 9 RCTs reported all-cause mortality, the rates of which were 25.6% among patients who received corticosteroids vs 27.4% among those in the control group. A subgroup analysis showed that corticosteroid use was associated with a decreased risk of all-cause mortality among patients with severe disease (relative risk [RR], 0.77; 95% CI, 0.68-0.88; P <.0001). For patients with nonsevere disease, all-cause mortality did not significantly differ on the basis of corticosteroid treatment (RR, 0.96; 95% CI, 0.86-1.06; P =.41).
In a pooled analysis, receipt of corticosteroid treatment was significantly associated with an increased length of hospitalization among patients with nonsevere COVID-19 infection (mean difference, 3.83; 95% CI, 1.11-6.56; P =.006).
Limitations included potential heterogeneity due to the inclusion of patients with severe and nonsevere COVID-19 infection, and the lack of standardized corticosteroid treatment among the included studies.
The researchers concluded that additional RCTs are needed to substantiate these findings.
Zeng Y, Zeng W, Yang B, Liu Z. Effectiveness of corticosteroids to treat coronavirus disease 2019 symptoms: A meta-analysis. Med Clin (Barc). Published online May 3, 2022. doi:10.1016/j.medcli.2022.03.013