The following is a summary of “Efficacy and safety of glucocorticoids use in patients with COVID-19: a systematic review and network meta‑analysis,” published in the December 2023 issue of Infectious Disease by He et al.
Despite promising evidence for glucocorticoids in reducing COVID-19 deaths and ventilator use, optimal dosing and regimens remain elusive. Researchers conducted a retrospective study to dissect the complex tapestry of glucocorticoid efficacy and safety across various regimens in the fight against COVID-19.
They started a meta-analysis of randomized controlled trials (December 30, 2022) from PubMed, Embase, Cochrane Library, CNKI Database, and Wanfang Database. Trials assessed glucocorticoids’ efficacy and safety against placebos in COVID-19 treatment. Examined diverse treatment options, including high-dose methylprednisolone, very high-dose methylprednisolone, pulse therapy methylprednisolone, medium-dose hydrocortisone, high-dose hydrocortisone, high-dose dexamethasone, very high-dose dexamethasone, and placebo. Examined 28-day mortality, hospitalization duration, ventilation, ICU admission, and safety outcomes.
The results showed 10,544 patients from 19 RCTs, encompassing 9 glucocorticoid treatment regimens of varying types and dosages. Regarding 28-day all-cause mortality, pulse therapy methylprednisolone demonstrated the lowest rate (OR 0.08, 95% CI 0.02, 0.42). In contrast, high-dose methylprednisolone, very high-dose dexamethasone, high-dose hydrocortisone, and medium-dose hydrocortisone showed no benefit. Compared to placebo, very high-dose methylprednisolone resulted in the shortest hospital stay (MD = -3.09; 95% CI: -4.10, -2.08), while high-dose dexamethasone and very high-dose dexamethasone did not provide a length-of-stay benefit (MD = -1.55; 95% CI: -3.13, 0.03 and MD = -1.06; 95% CI: -2.78, 0.67, respectively).
They concluded that glucocorticoid regimens could be critical to better COVID outcomes, especially pulse therapy for lower mortality and high doses for shorter stays.
Source: bmcinfectdis.biomedcentral.com/articles/10.1186/s12879-023-08874-w