Corticosteroids for COVID-19 (research up to 6 January 2022)
Citation: Wagner C, Griesel M, Mikolajewska A, et al. Systemic corticosteroids for the treatment of COVID-19: Equity-related analyses and update on evidence. Cochrane Database of Systematic Reviews. 2022;(11):CD014963.
Language: Abstract available in EN / ES / FA / FR. Plain language summary available in DE / EN / ES / FA / FR / HR. Full text available in EN.
Free to view: No.
Funding sources: Federal Ministry of Education and Research, Germany.
What is this? Corticosteroids are considered as a treatment for COVID-19 patients.
In this living Cochrane review, the authors searched for randomized trials of corticosteroids to treat COVID-19 patients. They did not restrict their searches by language of publication and did the search for this version of the review on 6 January 2022. They included 16 trials (9549 participants) and identified an additional 42 ongoing trials and 23 studies reported as being completed or terminated, but without results available.
What was found: At the time of this version of the review, the included studies provided moderate‐certainty evidence that systemic corticosteroids probably slightly reduce 30-day all‐cause mortality in people hospitalized because of symptomatic COVID‐19.
At the time of this version of the review, the included studies provided low‐certainty evidence that higher doses of systemic corticosteroids probably slightly reduce 30-day all‐cause mortality more than lower doses, in people hospitalized because of symptomatic COVID‐19.
At the time of this version of the review, only one randomised trial (86 participants) was available comparing methylprednisolone to dexamethasone and the evidence was very uncertain about their comparative effects.
At the time of this review, the included studies provided insufficient evidence to determine the effects of systemic corticosteroids on patients with asymptomatic or mild disease.
Implications: The authors are moderately certain that systemic corticosteroids probably slightly reduce all‐cause mortality up to 30 days amongst hospitalised, symptomatic COVID‐19 patients while level of respiratory support might play a critical role in patient selection. However, they stated that the applicability of the data is limited because it primarily came from European high‐income countries, limiting its applicability to settings different from that with regard to resources, climate and other infectious diseases. They also stated that the data were largely generated from unvaccinated participants and before the first occurrence of recent variants of SARS‐CoV‐2, meaning that the evidence may not be fully transferable to current patients.
Other considerations: The authors of the review discussed their findings in the context of place of residence (high-income versus low- and middle-income countries), ethnicity, sex and age.
This summary was prepared and finalized by Mike Clarke.