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. 2021 Mar 4;15:983–995. doi: 10.2147/DDDT.S298691

Table 1.

Main Characteristics and Findings of the Studies About COVID‐19 Patients Using Steroids

Author/Country Study Design Sample Size Grouping Age Male Gender Patient Condition Mortality Interventions/Treatments Recommendation
21 Galvez-Romero JL/Mexico Open-label, non-randomized study 209 Steroids/CsA plus steroids 54.06 ±13.8/55.3 ±13.3 61%/69% Moderate or severe 35%/22% (p=0.02) Methylprednisolone(0.5 mg/kg IV QD) or Prednisone(25 mg PO QD) up to 10 days; CsA (1–2 mg/kg PO QD) for 7 days CsA plus steroids can reduce mortality of patients with moderate to severe disease
22 Reiichiro Obata/America Retrospective study 226 Steroids/No steroids 70(59.5,79)/64(51, 76) 50.9%/59.2% COVID-19 patients OR[95% CI]:1.02,[0.60–1.73],(p=0.94) Not mentioned Steroids did not decrease or increase in-hospital mortality
23 Ana Fernández-Cruz/Spain Retrospective controlled cohort study 463 Steroids/No steroids 65.4/68.1 69.7%/61.2% Moderate or severe ARDS 26.2%/60%
(P=0.014)
1 mg/kg/day methylprednisolone for 10 days (IQR, 8 −13);
250 −500 mg/day methylprednisolone for 3 pulses (IQR, 2–4).
Glucocorticoids(initial regimen or pulses) can reduce mortality of patients with COVID-19
24 Kota Murohashi/Japan Cases report 11 Favipiravir plus methylprednisolone 63.2 73% Severe None Favipiravir (1.8 g BID on day 1, followed by 0.8 g BID for a total of 14 days) plus Methylprednisolone (80, 250, or 500 mg/day) for 3–6 days. The early-stage use of a combination of favipiravir and methylprednisolone in severe cases can achieve a favorable clinical outcome
25 Alejandro Rodríguez-Molinero/Spain Cohort study 418 Steroids/No steroids 65.4 56.9% COVID- 19 patients with pulmonary involvement 6 (8.1%)/10(13.2%) Methylprednisolone 1 mg/kg/day or dexamethasone 20–40 mg/day The mortality can not been analysed due to the low number of events. There is no benefit in the use of glucocorticoids in terms of lung function or time to discharge
26 Yan Hu/China Single-center study 308 Steroids/No steroids 54 (44–63)/48 (39–60) 47.2%/46.7% COVID- 19 patients with pulmonary involvement None Equivalent of methylprednisolone 0.75–1.5 mg/kg/d) Glucocorticoid therapy did not significantly influence the clinical course, adverse events nor the outcome of COVID-19 pneumonia
27 Muhammad A. Rana/PAK Retrospective quasi-experimental study 60 Dexamethasone/Methylprednisolone 53.8/53.9 66.7%/70% Patients treated in HDU/ICU and had been on bi-level positive airway pressure. Not mentioned Dexamethasone 8 mg BID/Methylprednisolone 40 mg BID; 8 days Dexamethasone is more effective in improving the P/F ratio in COVID-19 patients compared to methylprednisolone
28 Marla J Keller/UAS Observational study 1806 Steroids/No steroids 61.7 ± 15.9/62.3 ± 17.9 49.3%/46.3% COVID-19 patients Glucocorticoid increased mortality of patients with CRP< 10 mg/dL Early glucocorticoids (within 48 hours of admission) Choosing the right patients is critical to maximize the likelihood of benefit and minimize the risk of harm
29 Hong-Ming Zhu/China Single-center retrospective study 102 Steroids/No steroids Not mentioned 49.3%/57.6% Severe or critically ill log-rank 0.199, P = 0.655 Methylprednisolone 0.75–1.5 mg/kg/d, < 14 days Methylprednisolone treatment does not improve prognosis in severe and critical COVID-19 patients
30 Malgorzata Mikulska/Italy Observational single-center study 196 SOC plus early inflammatory treatment/SOC 64.5/73.5 70%/62% COVID-19 patients who were not intubated HROW = 0.48 95% CI,
0.23–0.99; p = 0.049
Tocilizumab (8mg/kg IV or 162mg subcutaneously) or methylprednisolone 1 mg/kg or both; 5 days Early administration of tocilizumab, methylprednisolone or both can mitigate he negative impact of immune response in COVID-19
31 V. Spagnuolo/Italy Retrospective study 280 Steroids/No steroids 67 (54–77)/62 (53–73) 78%/77.4% Moderate & severe 6.8%/3.6%,
(p = 0.29)
Initial methylprednisolone 0.87 (0.51–1.0) mg/Kg, discontinuation 0.38 (0.21–0.53) mg/Kg; 9 (7–16) days SARS-CoV-2 clearance was not associated with corticosteroid use but older age or a more severe disease
32 WHO REACT Working Group Prospective meta-analysis 1703 Steroids/No steroids 60(52–68) 71% Critically ill Summary OR, 0.66 [95% CI, 0.53–0.82]; P < 0.001 based on a fixed-effect meta-analysis Dexamethasone 15 mg/d, hydrocortisone 400 mg/d, or methylprednisolone 1 mg/kg/d Compared with usual care or placebo, systemic corticosteroids was associated with lower 28-day all-cause mortality
33 Soumya Sarkar/India Meta-analysis 15,754 Steroids/No steroids Not mentioned Not mentioned COVID-19 patients OR = 1.94, 95% CI: 1.11–3.4, I2 = 96% Methylprednisolone equivalent ≤ 40 mg/day or ≥ 50 mg/day Steroid increased mortality
34 Xiaofan Lu/China Retrospective study 244 Steroids/No steroids 62 (50–71) 52% Critically ill Every 10-mg increase in dosage was associated with additional 4% mortality risk (adjusted HR 1.04, 95% CI 1.01–1.07) Hydrocortisonee 200 mg/day (range 100–800), 8 days(4–12). Corticosteroid must be commenced with caution
35 Peter Horby/UK Controlled, open-label trial 6425 Steroids/No steroids 66.9±15.4/65.8±15.8 64%/64% COVID-19 patient 22.9%/25.7% (age-adjusted rate ratio, 0.83; 95% confidence interval [CI], 0.75 to 0.93; P<0.001) Dexamethasone 6 mg QD, PO or IV,10 days Dexamethasone can reduce mortality of patients who were receiving either invasive mechanical ventilation or oxygen alone but not among those receiving no respiratory support

Abbreviations: CsA, cyclosporine-A; IV, intravenous; QD, quaque die; PO, per os; COVID‐19, coronavirus disease‐2019; OR, odds ratio; CI, confidence interval; ARDS, acute respiratory distress syndrome; IQR, interquartile range; BID, bis in die; HDU, high-dependency unit; ICU, intensive care unit; P/F, partial oxygen pressure (PaO2)/inspired oxygen fraction (FiO2); CRP, C-reactive protein; SOC, standard of care; HR, hazard ratio; OW, overlap weights; SARS‐CoV‐2, severe acute respiratory syndrome coronavirus 2; REACT, Rapid Evidence Appraisal for COVID-19 Therapies.