Routine use of systemic glucocorticoids for patients with COVID-19 cannot be recommended

Objectives:
Glucocorticoids are widely used in the treatment of various pulmonary inflammatory diseases, but they are also often accompanied by significant adverse reactions. Published guidelines point out that low dose and short duration systemic glucocorticoid therapy may be considered for patients with rapidly progressing coronavirus disease 2019 (COVID-19) while the evidence is still limited. Therefore, this review article has been conducted.

What is the effectiveness and safety of glucocorticoids in children and adults with COVID-19, severe acute respiratory syndrome (SARS) and Middle East respiratory syndrome (MERS)?

Study design:
This review article included 1 RCT and 22 cohort studies, with a total of 13,815 patients.

Results and conclusions:   
The investigators found in adults with COVID-19, the use of systemic glucocorticoid did not reduce mortality [RR = 2.00, 95% CI = 0.69 to 5.75, I2 = 90.9%] or the duration of lung inflammation [WMD = -1 days, 95% CI = -2.91 to 0.91].

The investigators found in adults with COVID-19, the use of systemic glucocorticoid significantly reduced duration of fever [WMD = -3.23 days, 95% CI = -3.56 to -2.90].

The investigators found in patients with SARS, glucocorticoids also did not reduce the mortality [RR =1.52, 95% CI = 0.89 to 2.60, I2 = 84.6%], duration of fever [WMD = 0.82 days, 95% CI = -2.88 to 4.52, I2 = 97.9%] or duration of lung inflammation absorption [WMD = 0.95 days, 95% CI = -7.57 to 9.48, I2 = 94.6%].

The investigators found the use of systemic glucocorticoid therapy prolonged the duration of hospital stay in all patients (COVID-19, SARS and MERS).

The investigators found glucocorticoid use increased the risk of coinfections (bacterial or fungal) [RR = 3.5, 95% CI = 2.3 to 5.3, I2 = 0%], multiple organ dysfunction syndrome (MODS) [RR = 3.9, 95% CI = 2.1 to 6.9] and acute respiratory distress syndrome (ARDS) [RR = 6.1, 95% CI = 3.2 to 11.5].

The investigators concluded glucocorticoid therapy may increase the risk of death in patients with coronavirus infections who have mild symptoms and there is no association between glucocorticoids and mortality in patients with severe symptoms. In the context of clinical trials, low dose systemic glucocorticoid therapy for a short duration may be acceptable. Based on these findings, routine use of systemic glucocorticoids for patients with COVID-19 cannot be recommended.

Original title:
Effectiveness and Safety of Glucocorticoids to Treat COVID-19: A Rapid Review and Meta-Analysis by Lu S, Zhou Q, […], Peng D.

Link:
https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7290628/

Additional information of El Mondo:
Find more information/studies on coronavirus right here.