Additional steroid treatment for patients with influenza who are critically ill: Uncertain whether beneficial or harmful

Added March 16, 2020

Citation: Lansbury L, Rodrigo C, Leonardi-Bee J, et al. Corticosteroids as adjunctive therapy in the treatment of influenza. Cochrane Database of Systematic Reviews 2019; (2): CD010406.

What is this? Corticosteroids are widely used for people with severe influenza, but there is uncertainty about their potential benefits or harms. Corticosteroids have shown evidence of benefit in sepsis and related conditions, which is most likely due to their anti-inflammatory and immunomodulatory properties. Their effects in patients with influenza might indicate their likely effects in people seriously ill with COVID-19.

In this Cochrane systematic review, the authors searched for research (randomized trials, quasi-randomized trials and observational studies) which compared additional steroid treatment with no additional steroid treatment in people with influenza. They did not restrict by date, type or language of publication and did their searches in October 2018. They identified one randomized trial with two treatment groups and 29 observational studies. The randomized trial evaluated 24 participants with confirmed influenza infection but contained relatively few of the sickest patients, and none of the participants were in an intensive care unit at the time of randomization.

What works: Nothing reported.

What doesn’t work: Nothing reported.

What’s uncertain: Based on the non-randomized studies, people with influenza who receive additional steroid treatment may have a greater risk of death compared to those who do not receive steroid treatment. Hospital-acquired infection was the main ‘side effect’ of steroids. However, it is possible that patients with more severe influenza had been selected to receive steroid treatment in these studies, making it uncertain if additional steroid treatment is truly harmful in people with influenza.


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