Steroids for COVID-19 – Meta-analysis

Written by Clay Smith

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Use of steroids for critically ill patients with COVID-19 significantly reduced 28-day mortality.

Why does this matter?
RECOVERY showed likely benefit of dexamethasone in ill patients with COVID-19. In addition, 55 corticosteroid trials for COVID have been registered on ClinicalTrials.gov (most of which suspended enrollment after RECOVERY). So, what’s the consensus?

Corticosteroids look like a winner for sick COVID patients.
This was a very rapidly produced meta-analysis of 7 RCTs that included 1,703 patients with critical illness due to COVID-19. Six of seven studies were considered low risk for bias. When the studies were combined, there was a beneficial effect on the primary outcome, 28-day mortality, in patients who received steroids vs placebo; summary odds ratio 0.66 (95%CI 0.53-0.82). There was no increase in adverse events. The subgroups were not large enough to detect a difference among steroid types, whether dexamethasone, hydrocortisone, or methylprednisolone. Doses of dexamethasone ranged from 6mg to 20mg daily in the three studies; hydrocortisone was a 200mg total daily dose in the three studies; the single methylprednisolone study was 40mg twice a day. It seems reasonable, since RECOVERY made up 57% of the weight of this meta-analysis, to go with dexamethasone at a lower daily dose.

Source
Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis. JAMA. 2020 Sep 2. doi: 10.1001/jama.2020.17023. Online ahead of print.

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