Table 1.
Characteristics of included trials
| Trial | Region of trial | Trial type | Inclusion criteria | Timing of corticosteroids | Dosage and duration of corticosteroids (n) | Control intervention (n) | Primary outcome in each trial | Longest follow-up |
|---|---|---|---|---|---|---|---|---|
|
Angus et al.3 REMAP-CAP |
Australia, Canada, France, Ireland, the Netherlands, New Zealand, the UK, the USA | Multicenter, open-label, RCT | Aged at least 18 years | Given at study day 1 [1–4] |
A fixed 7-day course of intravenous hydrocortisone (50 or 100 mg every 6 h) (n = 137)a OR A shock-dependent course (50 mg every 6 h up to 28 d for shock patients) (n = 141) |
Usual care, no hydrocortisone (n = 101) | Respiratory and cardiovascular organ support-free days to 21 d | 21 d |
| Confirmed or suspected COVID-19 | ||||||||
| Admitted to ICU receiving respiratory or cardiovascular support | ||||||||
|
Corral et al.15 GLUCOCOVID |
Spain | Multicenter, partial randomized, preference, open-label controlled trial | Aged at least 18 years | Not specified | Methylprednisolone 80 mg/d for 3 d, then 40 mg/d for 3 d (n = 49)b | Standard of care, no corticosteroids (n = 29) | A composite of death, ICU admission, or requirement of noninvasive ventilation | Until composite endpoint happened |
| Confirmed COVID-19 | ||||||||
| Severe pneumonia, not intubated or ventilated | ||||||||
|
Dequin et al.4 CAPE COVID |
France | Multicenter, RCT | Aged at least 18 years | Within 24 h of the onset of the first severity criterion or within 48 h for patients referred from another hospital | Hydrocortisone 200 mg/d for 7 d, then 100 mg/d for 4 d and 50 mg/d for 3 d; if symptoms improved by day 4, then followed with hydrocortisone 100 mg/d for 2 d and 50mg/d for 2 d (n = 76) | Standard care (n = 73) | Death or persistent respiratory support on 21 d | 21 d |
| Confirmed or suspected COVID-19 | ||||||||
| Admitted to ICU with acute respiratory failure | ||||||||
| Edalatifard et al.16 | Iran | Multicenter, single-blind, RCT | Aged at least 18 years | Not specified | Methylprednisolone 250 mg/d for 3 d (n = 34) | Standard care (n = 28)b | Time to clinical improvement and hospital discharge or death | Until clinical improvement and hospital discharge or death |
| Confirmed COVID-19 | ||||||||
| Receiving oxygen therapy but not intubation or ventilation | ||||||||
|
Horby et al.2 RECOVERY |
UK | Multicenter, open-label, RCT | Not specified | Oral or intravenous dexamethasone 6 mg/d for up to 10 d (or until hospital discharge if sooner) (n = 1603) | Usual care (n = 3287) | All-cause mortality within 28 d after randomization | 28 d | |
| Confirmed or suspected COVID-19 | ||||||||
| Received respiratory supportc | ||||||||
|
Jeronimo et al.17 Metcovid |
Brazil | Single center, RCT | Aged at least 18 years | Not specified | Methylprednisolone 1 mg/kg/d for 5 d (n = 194) | Placebo (n = 199) | Mortality at 28 d | 28 d |
| Confirmed or suspected COVID-19 | ||||||||
| In use of oxygen therapy or under invasive mechanical ventilation | ||||||||
|
Tomazini et al.5 CoDEX trial |
Brazil | Multicenter, open-label, RCT | Aged at least 18 years | Not specified | Dexamethasone 20 mg/d for 5 d, then 10 mg/d for 5 d or until ICU discharge (n = 151) | Standard care (n = 148) | Ventilator-free days at 28 d | 28 d |
| Confirmed or suspected COVID-19 | ||||||||
| Receiving mechanical ventilation for ARDS |
aOnly two subjects were assigned 100 mg every 6 h for 7 days
bBased on per-protocol analysis
cThis trial also included patients not requiring oxygen therapy