Corticosteroids on the Management of Coronavirus Disease 2019 (COVID-19): A Systemic Review and Meta-Analysis

Mahmoud YOUSEFIFARD; Kosar  MOHAMED ALI; Abbas AGHAEI; Alireza  ZALI; Arian MADANI NEISHABOORI; Afshin ZARGHI; Saeed  SAFARI; Behrooz HASHEMI; Mohammad Mehdi  FOROUZANFAR; Mostafa HOSSEINI

doi:10.18502/ijph.v49i8.3863

Mahmoud YOUSEFIFARD
Kosar MOHAMED ALI
Abbas AGHAEI
Alireza ZALI
Arian MADANI NEISHABOORI
Afshin ZARGHI
Saeed SAFARI
Behrooz HASHEMI
Mohammad Mehdi FOROUZANFAR
Mostafa HOSSEINI

DOI: https://doi.org/10.18502/ijph.v49i8.3863

Keywords: : Coronavirus; Coronavirus infections; Glucocorticoids; Methylprednisolone

Abstract

Background: We aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV).

Method: An extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI).

Results: Fifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARSCoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections.

Conclusion: There is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID19 patients should be avoided.