Efficacy and Safety of Corticosteroid Use on Coronavirus Disease 2019 (COVID-19): A Systematic Review and Meta-Analysis

Abstract Background: We conducted a comprehensive literature review to synthesize evidence for the relationship between corticosteroid use and mortality in COVID-19 patients.Methods: The PUBMED, EMBASE, and Cochrane Library were searched from inception to March 13, 2021. We searched and analyzed randomized controlled trials (RCTs) and observational studies (OS) that examined the corticosteroid use in COVID-19 patients. The primary outcome was in-hospital mortality, while the secondary outcome was the need for mechanical ventilation (MV) and serious adverse events. Results: 11 RCTs and 46 OS involving 7,893 and 4,1696 COVID-19 patients were included in the study. Corticosteroid use was associated with lower COVID-19 mortality in RCTs, but was not statistically significant (OR, 0.88; 95% CI, 0.74–1.05; I2=66.9%). The subgroup analysis of severe COVID-19 patients, corticosteroid type and dose also showed no survival benefit statistically. However, the corticosteroid use may reduce the MV need (OR, 0.67; 95% CI, 0.51–0.90; I2=7.5%) with no significant increase in serious adverse reactions (OR, 0.84; 95% CI, 0.30–2.37; I2=33.3%). In addition, the included OS showed that the pulse dose (OR, 0.52; 95% CI, 0.39–0.70) and methylprednisolone use (OR, 0.69; 95% CI, 0.52–0.92; I2=66.7%) may lower the mortality in COVID-19 patients. Conclusions: This meta-analysis indicated that corticosteroid use might cause a slight reduction in COVID-19 mortality. However, it could significantly reduce the MV requirement in COVID-19 patients and restrict serious adverse events. Additionally, the pulse dose of methylprednisolone may be a good treatment choice for COVID-19 patients.