Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis
(1) Background: The use of corticosteroids in critical coronavirus infections, including severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), or Coronavirus disease 2019 (COVID-19), has been controversial. However, a meta-analysis on the efficacy of steroids in treating...
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MDPI AG
2020-07-01
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| Series: | Journal of Clinical Medicine |
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| Online Access: | https://www.mdpi.com/2077-0383/9/8/2392 |
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| author | Keum Hwa Lee Sojung Yoon Gwang Hun Jeong Jong Yeob Kim Young Joo Han Sung Hwi Hong Seohyun Ryu Jae Seok Kim Jun Young Lee Jae Won Yang Jinhee Lee Marco Solmi Ai Koyanagi Elena Dragioti Louis Jacob Joaquim Radua Lee Smith Hans Oh Kalthoum Tizaoui Sarah Cargnin Salvatore Terrazzino Ramy Abou Ghayda Andreas Kronbichler Jae Il Shin |
| author_facet | Keum Hwa Lee Sojung Yoon Gwang Hun Jeong Jong Yeob Kim Young Joo Han Sung Hwi Hong Seohyun Ryu Jae Seok Kim Jun Young Lee Jae Won Yang Jinhee Lee Marco Solmi Ai Koyanagi Elena Dragioti Louis Jacob Joaquim Radua Lee Smith Hans Oh Kalthoum Tizaoui Sarah Cargnin Salvatore Terrazzino Ramy Abou Ghayda Andreas Kronbichler Jae Il Shin |
| author_sort | Keum Hwa Lee |
| collection | DOAJ |
| description | (1) Background: The use of corticosteroids in critical coronavirus infections, including severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), or Coronavirus disease 2019 (COVID-19), has been controversial. However, a meta-analysis on the efficacy of steroids in treating these coronavirus infections is lacking. (2) Purpose: We assessed a methodological criticism on the quality of previous published meta-analyses and the risk of misleading conclusions with important therapeutic consequences. We also examined the evidence of the efficacy of corticosteroids in reducing mortality in SARS, MERS and COVID-19. (3) Methods: PubMed, MEDLINE, Embase, and Web of Science were used to identify studies published until 25 April 2020, that reported associations between steroid use and mortality in treating SARS/MERS/COVID-19. Two investigators screened and extracted data independently. Searches were restricted to studies on humans, and articles that did not report the exact number of patients in each group or data on mortality were excluded. We calculated odds ratios (ORs) or hazard ratios (HRs) under the fixed- and random-effect model. (4) Results: Eight articles (4051 patients) were eligible for inclusion. Among these selected studies, 3416 patients were diagnosed with SARS, 360 patients with MERS, and 275 with COVID-19; 60.3% patients were administered steroids. The meta-analyses including all studies showed no differences overall in terms of mortality (OR 1.152, 95% CI 0.631–2.101 in the random effects model, <i>p</i> = 0.645). However, this conclusion might be biased, because, in some studies, the patients in the steroid group had more severe symptoms than those in the control group. In contrast, when the meta-analysis was performed restricting only to studies that used appropriate adjustment (e.g., time, disease severity), there was a significant difference between the two groups (HR 0.378, 95% CI 0.221–0.646 in the random effects model, <i>p</i> < 0.0001). Although there was no difference in mortality when steroids were used in severe cases, there was a difference among the group with more underlying diseases (OR 3.133, 95% CI 1.670–5.877, <i>p</i> < 0.001). (5) Conclusions: To our knowledge, this study is the first comprehensive systematic review and meta-analysis providing the most accurate evidence on the effect of steroids in coronavirus infections. If not contraindicated, and in the absence of side effects, the use of steroids should be considered in coronavirus infection including COVID-19. |
| first_indexed | 2024-03-10T18:11:45Z |
| format | Article |
| id | doaj.art-1ae77da972f54082993c5a9307a06a55 |
| institution | Directory Open Access Journal |
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| language | English |
| last_indexed | 2024-03-10T18:11:45Z |
| publishDate | 2020-07-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Clinical Medicine |
| spelling | doaj.art-1ae77da972f54082993c5a9307a06a552023-11-20T08:03:27ZengMDPI AGJournal of Clinical Medicine2077-03832020-07-0198239210.3390/jcm9082392Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-AnalysisKeum Hwa Lee0Sojung Yoon1Gwang Hun Jeong2Jong Yeob Kim3Young Joo Han4Sung Hwi Hong5Seohyun Ryu6Jae Seok Kim7Jun Young Lee8Jae Won Yang9Jinhee Lee10Marco Solmi11Ai Koyanagi12Elena Dragioti13Louis Jacob14Joaquim Radua15Lee Smith16Hans Oh17Kalthoum Tizaoui18Sarah Cargnin19Salvatore Terrazzino20Ramy Abou Ghayda21Andreas Kronbichler22Jae Il Shin23Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, KoreaYonsei University College of Medicine, Seoul 03722, KoreaCollege of Medicine, Gyeongsang National University, Jinju 52727, KoreaYonsei University College of Medicine, Seoul 03722, KoreaDepartment of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, KoreaDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USAYonsei University College of Medicine, Seoul 03722, KoreaDepartment of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Psychiatry, Yonsei University Wonju College of Medicine, Wonju 26426, KoreaDepartment of Neuroscience, University of Padova, 35121 Padova, ItalyResearch and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, SpainPain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linkoping University, SE-581 85 Linkoping, SwedenResearch and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, SpainInstitut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, SpainThe Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UKSchool of Social Work, University of Southern California, Los Angeles, CA 90015, USADepartment of Basic Sciences, Division of Histology and Immunology, Faculty of Medicine Tunis, Tunis El Manar University, Tunis 1068, TunisiaDepartment of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100 Novara, ItalyDepartment of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100 Novara, ItalyDepartment of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USADepartment of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, AustriaDepartment of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea(1) Background: The use of corticosteroids in critical coronavirus infections, including severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), or Coronavirus disease 2019 (COVID-19), has been controversial. However, a meta-analysis on the efficacy of steroids in treating these coronavirus infections is lacking. (2) Purpose: We assessed a methodological criticism on the quality of previous published meta-analyses and the risk of misleading conclusions with important therapeutic consequences. We also examined the evidence of the efficacy of corticosteroids in reducing mortality in SARS, MERS and COVID-19. (3) Methods: PubMed, MEDLINE, Embase, and Web of Science were used to identify studies published until 25 April 2020, that reported associations between steroid use and mortality in treating SARS/MERS/COVID-19. Two investigators screened and extracted data independently. Searches were restricted to studies on humans, and articles that did not report the exact number of patients in each group or data on mortality were excluded. We calculated odds ratios (ORs) or hazard ratios (HRs) under the fixed- and random-effect model. (4) Results: Eight articles (4051 patients) were eligible for inclusion. Among these selected studies, 3416 patients were diagnosed with SARS, 360 patients with MERS, and 275 with COVID-19; 60.3% patients were administered steroids. The meta-analyses including all studies showed no differences overall in terms of mortality (OR 1.152, 95% CI 0.631–2.101 in the random effects model, <i>p</i> = 0.645). However, this conclusion might be biased, because, in some studies, the patients in the steroid group had more severe symptoms than those in the control group. In contrast, when the meta-analysis was performed restricting only to studies that used appropriate adjustment (e.g., time, disease severity), there was a significant difference between the two groups (HR 0.378, 95% CI 0.221–0.646 in the random effects model, <i>p</i> < 0.0001). Although there was no difference in mortality when steroids were used in severe cases, there was a difference among the group with more underlying diseases (OR 3.133, 95% CI 1.670–5.877, <i>p</i> < 0.001). (5) Conclusions: To our knowledge, this study is the first comprehensive systematic review and meta-analysis providing the most accurate evidence on the effect of steroids in coronavirus infections. If not contraindicated, and in the absence of side effects, the use of steroids should be considered in coronavirus infection including COVID-19.https://www.mdpi.com/2077-0383/9/8/2392corticosteroidscoronavirussevere acute respiratory syndrome (SARS)Middle East respiratory syndrome (MERS)coronavirus disease 2019 (COVID-19) |
| spellingShingle | Keum Hwa Lee Sojung Yoon Gwang Hun Jeong Jong Yeob Kim Young Joo Han Sung Hwi Hong Seohyun Ryu Jae Seok Kim Jun Young Lee Jae Won Yang Jinhee Lee Marco Solmi Ai Koyanagi Elena Dragioti Louis Jacob Joaquim Radua Lee Smith Hans Oh Kalthoum Tizaoui Sarah Cargnin Salvatore Terrazzino Ramy Abou Ghayda Andreas Kronbichler Jae Il Shin Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis Journal of Clinical Medicine corticosteroids coronavirus severe acute respiratory syndrome (SARS) Middle East respiratory syndrome (MERS) coronavirus disease 2019 (COVID-19) |
| title | Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis |
| title_full | Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis |
| title_fullStr | Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis |
| title_full_unstemmed | Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis |
| title_short | Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis |
| title_sort | efficacy of corticosteroids in patients with sars mers and covid 19 a systematic review and meta analysis |
| topic | corticosteroids coronavirus severe acute respiratory syndrome (SARS) Middle East respiratory syndrome (MERS) coronavirus disease 2019 (COVID-19) |
| url | https://www.mdpi.com/2077-0383/9/8/2392 |
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