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. 2020 Jun 27;14(5):971–978. doi: 10.1016/j.dsx.2020.06.054

Table 3.

Studies in COVID -19 where corticosteroid was used to evaluated outcome.

Author/Study, Year Median Age (years) N Type of study (S/M) Type of steroid and dose, (n) Median day/time of steroid initiation after admission Associated medical treatment Treatment outcome
Wu et al. [28], 2020 61 1514 (severe) Retro, M Equivalent to 40 mg MP daily (n = 531, 35.1%) Median Time 2.2 h,
In 359 (67.6%) patients within first-24 h		 Not specified
  • •

    No increase or decrease in 28-day hospital mortality (propensity-matched adjusted HR 1.55; 95% CI, 0.83–2.87; p = 0.166) in severe cases.
68 249 (critical) Retro, M Equivalent to 40 mg MP daily (n = 159, 63.1%) Median time 0.6 h,
In 127 (79.9%) patients within first-24 h		 Not specified
  • •

    Increase in 28-day hospital mortality (propensity-matched adjusted HR 2.90; 95% CI, 1.17–7.16; p = 0.021) in critical cases.
Lu et al. [29], 2020 62 244 Retro, S MP, Dexa and HC (dosage equivalent 100–800 mg of HC)
(n = 151, 62%)		 Not specified Oseltamivir,
Arbidol,
Ganciclovir,
L/R,
IFN α
  • •

    Corticosteroid treatment independent of mortality in multivariate analysis with propensity score matching (adjusted OR 1.05; 95% CI, −1.92 to 2.1).

  • •

    28-day mortality 39 vs. 16% (steroid users vs. controls, p = 0.09)a in propensity score matched case control study.
Fadel et al. [30], 2020 61 213 (MP-132,
SOC-81)		 Quasi-P, M 0.5–1 mg/kg/day of MP IV in 2 divided dosage X 3–7 days (ICU), X 3 days (non -ICU),
(n = 132, 62%)		 Median time to steroid initiation 2 days. Within first-48 h in majority (n = 65, 30.5%). Greater initiation of steroid in the post corticosteroid group within 48 h (12.4% vs. 41.7%,
p < 0.001)		 L/R,
Remdesivir, Ribavirin,
HCQ
  • •

    Significant lowering of a composite of transfer to ICU/new MV/death with IV MP in the MP group vs. SOC (34.9% vs. 54.3%, p = 0.005).

  • •

    Reduced incidence of ARDS in the MP group vs. SOC (26.6% vs. 38.3%, p = 0.004).

  • •

    Independent reduction in the composite endpoint at 14-days controlling for other factors in MP group vs. SOC (aOR 0.45; 95% CI 0.25–0.81).

  • •

    Significant lowering in median duration of hospital stay in MP group vs. SOC (8 days vs. 5 days, p < 0.001)
Wang et al. [31], 2020 54 46 Retro, S 1–2 mg/kg/day IV MP X 5–7 days (n = 26) Within first-24 h L/R,
IFN-α,
Thymosin
  • •

    Quicker temperature normalization in MP group, compared to the control (2.06 ± 0.28 vs. 4.39 ± 0.70 days, p = 0.010)

  • •

    Decreased requirement of supplemental O2 therapy in the MP group, compared to the control (8.2 vs. 13.5 days, p < 0.001].
Choroboczek et al. [32], 2020 61 (mean) 70 Retro, S Corticosteroids unspecified (n = 21, 30%) At least 7 days after onset of symptoms AZ (41%)
HCQ (17%)
L/R (7.5%)
  • •

    Decreased risk of intubation and subsequent ventilation by 47% (95% CI, −71.8 to −22.5%, p = 0.004)
RECOVERY Trial [14],
2020		 <70 : 54%
70-80 : 22%
>80 : 24%		 6425 RCT,
M		 Dexa 6 mg/day X 10 days (n = 2104) vs. no Dexa (n = 4321),
Median duration of treatment 6 days.		 Within first-24 h AZ (23%)
(AZ 24% in control arm),
Very few received HCQ, L/R
  • •
    Decrease death by
    • -
      17% in all participants (RR 0.83, 95% CI, 0.74–0.92; p < 0.001).
    • -
      35% in patients on invasive ventilation (RR 0.65; 95% CI 0.48–0.88; p = 0.0003).
    • -
      20% in patients on O2 with or without noninvasive ventilation (RR 0.80; 95% CI 0.67–0.96; p = 0.0021).
  • •

    11% higher probability of early discharge by day 28 (RR 1.11; 95% CI, 1.04–1.19; p = 0.002)

  • •

    No benefit in patients without O2 support or invasive ventilation (RR 1.22; 95% CI 0.93–1.61, p = 0.14).
a

Increased corticosteroids dosage associated with elevated mortality risk (P = 0.003) in matched cases after adjustment for duration of therapy; every 10 mg increase in HC dosage associated with 4% increase in mortality risk (adjusted HR: 1.04,95% CI: 1.01–1.07), MP- Methyl Prednisolone, Dexa- Dexamethasone, HC- Hydrocortisone, IFN-α- Interferon α, HCQ- Hydroxychloroquine, HR- Hazard ratio, RR- Rate ratio, aOR-adjusted Odd’s ratio, AZ- Azithromycin, SOC- Standard of care, O2- Oxygen therapy, L/R- Lopinavir/Ritonavir, Retro- Retrospective, S- Single center, M- Multicentric, P- Prospective, RCT- Randomized control trial.