Corticosteroids on the Management of Coronavirus Disease 2019 (COVID-19): A Systemic Review and Meta-Analysis
Background: We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV).
Method: An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI).
Results: Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections.
Conclusion: There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.
2. Rismanbaf A (2020). Potential treatments for COVID-19; a literature review. Arch Acad Emerg Med, 8(1):e29.
3. Yousefifard M, Zali A, Mohamed Ali K, et al (2020). Antiviral therapy in management of COVID-19: a systematic review on current evidence. Arch Acad Emerg Med, 8(1):e45.
4. Arabi YM, Mandourah Y, Al-Hameed F, et al (2018). Corticosteroid therapy for critically ill patients with middle east respiratory syndrome. Am J Respir Crit Care Med, 197(6):757-767.
5. Stockman LJ, Bellamy R, Garner P (2006). SARS: systematic review of treatment effects. PLoS Med, 3(9):e343.
6. WHO. Clinical management of severe acute respiratory infection when novel coronavirus (nCoV) infection is suspected. Geneva; 2020 28 Feb 2020.
7. Wu C, Chen X, Cai Y, et al (2020). Risk Factors Associated with Acute Respiratory Distress Syndrome and Death in Patients with Coronavirus Disease 2019 Pneumonia in Wuhan, China. JAMA Intern Med, 180(7): 1–11.
8. Higgins JP, Altman DG, Gøtzsche PC, et al (2011). The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ, 343:d5928.
9. Amici C, Di Caro A, Ciucci A, et al (2006). Indomethacin has a potent antiviral activity against SARS coronavirus. Antivir Ther, 11(8):1021-30.
10. Group GW (2004). Grading quality of evidence and strength of recommendations. BMJ, 328(7454):1490.
11. Alfaraj SH, Al-Tawfiq JA, Assiri AY, et al (2019). Clinical predictors of mortality of Middle East Respiratory Syndrome Coronavirus (MERS-CoV) infection: A cohort study. Travel Med Infect Dis, 29:48-50.
12. Auyeung TW, Lee JSW, Lai WK, et al (2005). The use of corticosteroid as treatment in SARS was associated with adverse outcomes: A retrospective cohort study. Journal of Infection, 51(2):98-102.
13. Chen RC, Tang XP, Tan SY, et al (2006). Treatment of severe acute respiratory syndrome with glucosteroids: The Guangzhou experience. Chest, 129(6):1441-52.
14. Jia WD, Deng XL, Tang XP, et al (2009). [Dose of glucocorticosteroids in the treatment of severe acute respiratory syndrome]. Nan Fang Yi Ke Da Xue Xue Bao, 29(11):2284-7.
15. Lee N, Allen Chan KC, Hui DS, et al (2004). Effects of early corticosteroid treatment on plasma SARS-associated Coronavirus RNA concentrations in adult patients. J Clin Virol, 31(4):304-9.
16. Liu W, Tao ZW, Lei W, et al (2020). Analysis of factors associated with disease outcomes in hospitalized patients with 2019 novel coronavirus disease. Chin Med J (Engl), 133(9): 1032–1038.
17. Meng QH, Dong PL, Guo YB, et al (2003). [Use of glucocorticoid in treatment of severe acute respiratory syndrome cases]. Zhonghua Yu Fang Yi Xue Za Zhi, 37(4):233-5.
18. Song ZF, Guo XH, Wang SY, et al (2003).[ Evaluation of glucocorticoid in treatment for patients with acute respiratory distress syndrome]. Zhongguo Wei Zhong Bing Ji Jiu Yi Xue, 15(6):349-53.
19. Wang GF, Li N, Wu YF, et al (2004). [The COX regression analysis on the use of corticosteroids in the treatment of SARS]. Zhonghua Yi Xue Za Zhi, 84(13):1073-8.
20. Wang Y, Jiang W, He Q, et al (2020). Early, low-dose and short-term application of corticosteroid treatment in patients with severe COVID-19 pneumonia: single-center experience from Wuhan, China. medRxiv, doi: https://doi.org/10.1101/2020.03.06.20032342.
21. Yin-Chun Yam L, Chun-Wing Lau A, Yuk-Lin Lai F, et al (2007). Corticosteroid treatment of severe acute respiratory syndrome in Hong Kong. J Infect, 54(1):28-39.
22. Chen Q, Quan B, Li X, et al (2020). A report of clinical diagnosis and treatment of 9 cases of coronavirus disease 2019. J Med Virol, 92(6):683-687.
23. Zhou F, Yu T, Du R, et al (2020). Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. Lancet (London, England), 395(10229):1054-62.
24. Lansbury L, Rodrigo C, Leonardi‐Bee J, et al (2019). Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database Syst Rev, 2(2):CD010406.
25. Ni Y-N, Chen G, Sun J, Liang B-M, Liang Z-A (2019). The effect of corticosteroids on mortality of patients with influenza pneumonia: a systematic review and meta-analysis. Crit Care, 23(1):99.
26. Lansbury LE, Rodrigo C, Leonardi-Bee J, et al (2020). Corticosteroids as adjunctive therapy in the treatment of influenza: An updated Cochrane systematic review and meta-analysis. Crit Care Med, 48(2):e98-e106.
27. Ruan S-Y, Lin H-H, Huang C-T, et al (2014). Exploring the heterogeneity of effects of corticosteroids on acute respiratory distress syndrome: a systematic review and meta-analysis. Crit Care, 18(2):R63.
28. Zhou Y, Fu X, Liu X, et al (2020). Use of corticosteroids in influenza-associated acute respiratory distress syndrome and severe pneumonia: a systemic review and meta-analysis. Sci Rep, 10(1):3044.
29. Zhao Q, Shi JX, Hu R, et al (2019). Effect of glucocorticoids on mortality in patients with acute respiratory distress syndrome: A meta‑analysis. Exp Ther Med, 18(6): 4913–4920.