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Efficacy and safety of systematic corticosteroids among severe COVID-19 patients: a systematic review and meta-analysis of randomized controlled trials
- Source :
- Signal Transduction and Targeted Therapy, Vol 6, Iss 1, Pp 1-7 (2021), Signal Transduction and Targeted Therapy
- Publication Year :
- 2021
- Publisher :
- Nature Publishing Group, 2021.
-
Abstract
- The benefits and harms of corticosteroids for patients with severe coronavirus disease 2019 (COVID-19) remain unclear. We systematically searched PubMed, Embase, and Cochrane Central Register of Controlled Trials from December 31, 2019 to October 1, 2020 to identify randomized controlled trials (RCTs) that evaluated corticosteroids in severe COVID-19 patients. The primary outcome was all-cause mortality at the longest follow-up. Secondary outcomes included a composite disease progression (progression to intubation, ventilation, extracorporeal membrane oxygenation, ICU transfer, or death among those not ventilated at enrollment) and incidence of serious adverse events. A random-effects model was applied to calculate risk ratio (RR) with 95% confidence intervals (CIs). We used the Grading of Recommendations Assessment, Development, and Evaluation approach to evaluate the certainty of the evidence. Seven RCTs involving 6250 patients were included, of which the Randomized Evaluation of COVID-19 Therapy (RECOVERY) trial comprised nearly 78% of all included subjects. Results showed that corticosteroids were associated with a decreased all-cause mortality (27.3 vs. 31.1%; RR: 0.85; 95% CI: 0.73–0.99; P = 0.04; low-certainty evidence). Trial sequential analysis suggested that more trials were still required to confirm the results. However, such survival benefit was absent if RECOVERY trial was excluded (RR: 0.83; 95% CI: 0.65–1.06; P = 0.13). Furthermore, corticosteroids decreased the occurrence of composite disease progression (30.6 vs. 33.3%; RR: 0.77; 95% CI: 0.64–0.92; P = 0.005), but not increased the incidence of serious adverse events (3.5 vs. 3.4%; RR: 1.16; 95% CI: 0.39–3.43; P = 0.79).
- Subjects :
- Cancer Research
medicine.medical_specialty
lcsh:Medicine
Review Article
030204 cardiovascular system & hematology
Severity of Illness Index
Disease-Free Survival
law.invention
03 medical and health sciences
0302 clinical medicine
Randomized controlled trial
Adrenal Cortex Hormones
law
Internal medicine
Severity of illness
Genetics
medicine
Humans
030212 general & internal medicine
Adverse effect
Survival rate
lcsh:QH301-705.5
Randomized Controlled Trials as Topic
SARS-CoV-2
business.industry
Incidence (epidemiology)
lcsh:R
COVID-19
Confidence interval
Survival Rate
lcsh:Biology (General)
Meta-analysis
Relative risk
Infectious diseases
Immunotherapy
business
Subjects
Details
- Language :
- English
- ISSN :
- 20593635
- Volume :
- 6
- Issue :
- 1
- Database :
- OpenAIRE
- Journal :
- Signal Transduction and Targeted Therapy
- Accession number :
- edsair.doi.dedup.....d2a78b2dfe05af411836034eb0ddcd2a