A Meta-Analysis Of The Association Between Systemic Corticosteroids And The Efficacy Of COVID-19

Objective:To systematically evaluate the efficacy and safety of systemic corticosteroids in the treatment of novel coronavirus disease 2019(COVID-19)to provide a reference for clinical dosing options.Methods:A computerised search of the literature on the efficacy of systemic corticostero-ids for the treatment of patients with COVID-19 published in Pubmed,Embase and Cochrane library databases up to September 2022 was conducted and the literature was screened according to inclusion and exclusion criteria,and the final selected literature was risk assessed using the Cochrane Risk of Bias Tool.The extracted data were statistically analysed using STATA 17.0 and Rev Man 5.4.Results:A total of 12 RCTs involving 8086 patients with COVID-19 were included in this study,including 5057 controls and 3029 patients treated with systemic corticoster-oids.Results showed that:1.Compared with the control group,treatment with systemic corticosteroids significantly reduced mortality in patients with COVID-19 [RR=0.89,95% CI(0.82-0.96),P=0.0018];subgroup analysis found that dexamethasone treatment significan-tly reduced mortality in patients with COVID-19 [RR=0.90,95% CI(0.83-0.98),P=0.012],while hydrocortisone and methylprednisolone treatment had no statistically significant effect on mortality in patients with COVID-19 [RR=0.84,95% CI(0.84-0.98),P=0.012],while hydrocortisone and methylprednisolone treatment had no statistically significant effect on mortality in patients with COVID-19 [RR=0.84,95% CI(0.49-1.44),P=0.533],[RR=0.68,95% CI(0.32-1.42),P=0.301];low and pulsed doses of systemic corticosteroids reduced mortality in COVID-19 patients [RR=0.89,95% CI(0.82-0.97),P=0.006],[RR=0.20,95% CI(0.06-0.63),P=0.006],while high-dose corticosteroids were not associated with mortality in COVID-19 patients [RR= 0.95,95% CI(0.80-1.13),P=0.543];there was a survival benefit with systemic corticosteroid use for ≥7 days [RR=0.89,95% CI(0.82-0.98)];and no statistically significant effect of mechanical ventilation on mortality at baseline [RR=0.85,95% CI(0.72-1.02),P=0.08] and [RR=0.78,95% CI(0.51-1.20),P=0.16];2.Systemic corticosteroid treatment of patients with C0VID-19 reduces the need for invasive mechanical ventilation [RR=0.74,95% CI(0.64-0.87),P=0.0002];3.The occurrence of serious adverse events,adverse events,secondary infections and hyperglycaemia did not correlate with the use of systemic corticosteroids.Conclusions:Compared with controls,systemic corticosteroid treatment was effective in reducing all-cause mortality and the need for mechanical ventilation in patients with COVID-19 and did not increase the incidence of adverse events;and in a subgroup analysis,a significant survival benefit was found in patients with COVID-19 treated with low-dose systemic corticosteroids and treatment duration ≥7 days,while patients treated with dexamethasone The survival benefit was better than that of patients treated with hydrocortisone or methylprednisolone.