Table 1. Effect of corticosteroids in coronavirus disease-2019.
| Study (year) | Type of study | Control | Treatment | Number of patients | Outcome | Ref. |
|---|---|---|---|---|---|---|
| Zhang et al. (2020) | Systematic review and meta-analysis | Standard care | Different available treatments | 45 studies with 4203 patients | Corticosteroids were associated with a higher rate of ARDS | [30] |
| Veronese et al. (2020) | Systematic review | Standard care | Methylprednisolone | Four studies with 542 Chinese patients | From four studies, each reported a different outcome • Intravenous methylprednisolone: no benefit • Greater risk of ICU admission (72.2 vs 35.3%, p < 0.001) • Methylprednisolone decreased mortality, HR: 0.38 (0.20–0.72) • Delayed viral clearance: corticosteroids vs control oropharyngeal swabs: 15 vs 8 days Feces: 20 vs 11 days |
[31] |
| Zhong et al. (2020) | Meta-analysis | Standard care | Different available treatments | 18 studies with 4941 patients (SARS, MERS and COVID-19) | A combination of ribavirin and corticosteroids decreased mortality (RR: 0.43, 95% CI: 0.27–0.68) | [32] |
| Fadel et al. (2020) | Multicenter quasi-experimental study | Standard care | Low-dose iv. methylprednisolone 0.5–1 mg/kg/day two divided doses for 3 days | 231 patients (81/132) | • Mortality: 0.45 (0.22–0.91) • Respiratory failure requiring mechanical ventilation: 0.47 (0.25–0.92) • Escalation to ICU: 0.47 (0.25–0.88) |
[33] |
| Zha et al. (2020) | Observational study | Standard care | Corticosteroids | 31 patients | • Virus clearance time: HR: 1.26 (0.58–2.74) • Length of hospital stay: 0.77 (0.33–1.78) • Duration of symptoms: 0.86 (0.40–1.83) |
[34] |
| Gong et al. (2020) | Retrospective study | Standard care | Methylprednisolone | 34 patients under 50 years age | Relieved the symptoms • Persistent fever • Difficult breathing • Improve oxygenation Prevented disease progression |
[35] |
| Fang et al. (2020) | Retrospective analysis | Standard care | Low-dose methylprednisolone | 78 patients | No difference in time to viral clearance | [36] |
| Selvaraj et al. (2020) | Case series | Nil | Dexamethasone | 21 patients | 78% of patients discharged Length of hospital stay: 7.8 days |
[37] |
| Li et al. (2020) | Retrospective analysis | Standard care | Methylprednisolone | 206 patients | High dose (80 mg/day) delayed viral shedding of patients | [38] |
| Yuan et al. (2020) | Retrospective cohort study based on propensity-score matched analysis | Standard care | Methylprednisolone | 70 patients with non-severe COVID-19 pneumonia | Corticosteroid group, more patients progressed to severe disease 11.4 vs 2.9% (p = 0.353) |
[39] |
| RECOVERY trial (2020) | Randomized controlled study | Standard care | Dexamethasone | 4321 patients control and 2104 patients in treatment group | Mortality: • Age-adjusted RR = 0.83 (95% CI: 0.74–0.92; p < 0.001) • Patients on invasive mechanical ventilation (29.0 vs 40.7%; RR: 0.65; 95% CI: 0.51–0.82; p < 0.001) • Patients who were on oxygen (21.5 vs 25.0%; RR: 0.80; 95% CI: 0.70–0.92; p = 0.002) • Patients who did not receive respiratory support at randomization (17.0 vs 13.2%; RR: 1.22; 95% CI: 0.93–1.61; p = 0.14). |
[40] |
ARDS: Acute respiratory distress syndrome; COVID-19: Coronavirus disease-2019; HR: Hazard ratio; ICU: Intensive care unit; iv.: Intravenous; MERS: Middle East respiratory syndrome; RR: Rate ratio.