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.