PT  - JOURNAL ARTICLE
AU  - Ye, Zhikang
AU  - Wang, Ying
AU  - Colunga-Lozano, Luis Enrique
AU  - Prasad, Manya
AU  - Tangamornsuksan, Wimonchat
AU  - Rochwerg, Bram
AU  - Yao, Liang
AU  - Motaghi, Shahrzad
AU  - Couban, Rachel J.
AU  - Ghadimi, Maryam
AU  - Bala, Malgorzata M.
AU  - Gomaa, Huda
AU  - Fang, Fang
AU  - Xiao, Yingqi
AU  - Guyatt, Gordon H.
TI  - Efficacy and safety of corticosteroids in COVID-19 based on evidence for COVID-19, other coronavirus infections, influenza, community-acquired pneumonia and acute respiratory distress syndrome: a systematic review and meta-analysis
AID  - 10.1503/cmaj.200645
DP  - 2020 Jul 06
TA  - Canadian Medical Association Journal
PG  - E756--E767
VI  - 192
IP  - 27
4099  - http://www.cmaj.ca/content/192/27/E756.short
4100  - http://www.cmaj.ca/content/192/27/E756.full
SO  - CMAJ2020 Jul 06; 192
AB  - BACKGROUND: Very little direct evidence exists on use of corticosteroids in patients with coronavirus disease 2019 (COVID-19). Indirect evidence from related conditions must therefore inform inferences regarding benefits and harms. To support a guideline for managing COVID-19, we conducted systematic reviews examining the impact of corticosteroids in COVID-19 and related severe acute respiratory illnesses.METHODS: We searched standard international and Chinese biomedical literature databases and prepublication sources for randomized controlled trials (RCTs) and observational studies comparing corticosteroids versus no corticosteroids in patients with COVID-19, severe acute respiratory syndrome (SARS) or Middle East respiratory syndrome (MERS). For acute respiratory distress syndrome (ARDS), influenza and community-acquired pneumonia (CAP), we updated the most recent rigorous systematic review. We conducted random-effects meta-analyses to pool relative risks and then used baseline risk in patients with COVID-19 to generate absolute effects.RESULTS: In ARDS, according to 1 small cohort study in patients with COVID-19 and 7 RCTs in non–COVID-19 populations (risk ratio [RR] 0.72, 95% confidence interval [CI] 0.55 to 0.93, mean difference 17.3% fewer; low-quality evidence), corticosteroids may reduce mortality. In patients with severe COVID-19 but without ARDS, direct evidence from 2 observational studies provided very low-quality evidence of an increase in mortality with corticosteroids (hazard ratio [HR] 2.30, 95% CI 1.00 to 5.29, mean difference 11.9% more), as did observational data from influenza studies. Observational data from SARS and MERS studies provided very low-quality evidence of a small or no reduction in mortality. Randomized controlled trials in CAP suggest that corticosteroids may reduce mortality (RR 0.70, 95% CI 0.50 to 0.98, 3.1% lower; very low-quality evidence), and may increase hyperglycemia.INTERPRETATION: Corticosteroids may reduce mortality for patients with COVID-19 and ARDS. For patients with severe COVID-19 but without ARDS, evidence regarding benefit from different bodies of evidence is inconsistent and of very low quality.See related article at www.cmaj.ca/lookup/doi/10.1503/cmaj.200648