Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19: A Meta-analysis
Pooled data from 7 RCTs (n=1703) found administration of systemic corticosteroids, compared with usual care or placebo, was associated with lower 28-day all-cause mortality (222/678 [32.7%] died vs. 425/1025 [41.5%], OR, 0.66; 95% CI, 0.53-0.82; p <0 .001).
Source:
Journal of the American Medical Association
SPS commentary:
This meta-analysis was published in JAMA along with 3 randomised trials of corticosteroids:
According to an editorial, these data represent an important step forward in the treatment of patients with COVID-19. It notes that while the RECOVERY results were embraced because they provided hope in the treatment of this catastrophic disease, numerous study limitations prevented complete confidence in using corticosteroids in hospitalized patients with COVID-19. It adds that these trials and the meta-analysis have strengthened confidence, further defined the benefit, and shifted usual care of COVID-19–related acute respiratory distress syndrome. (ARDS) to include corticosteroids.
It warns however that many clinically important questions remain.
While much work remains on the exact details of implementation into clinical practice, it concludes for now that the consistent findings of benefit in these studies provide definitive data that corticosteroids should be first-line treatment for critically ill patients with COVID-19.
Following publication of the REMAP-CAP trial and this meta-analysis, the World Health Organization has issued new interim guidance recommending the use of systemic corticosteroids in severe and critical COVID-19 disease as follows: