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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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Autores principales: Lee, Keum Hwa, Yoon, Sojung, Jeong, Gwang Hun, Kim, Jong Yeob, Han, Young Joo, Hong, Sung Hwi, Ryu, Seohyun, Kim, Jae Seok, Lee, Jun Young, Yang, Jae Won, Lee, Jinhee, Solmi, Marco, Koyanagi, Ai, Dragioti, Elena, Jacob, Louis, Radua, Joaquim, Smith, Lee, Oh, Hans, Tizaoui, Kalthoum, Cargnin, Sarah, Terrazzino, Salvatore, Ghayda, Ramy Abou, Kronbichler, Andreas, Shin, Jae Il
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2020
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465945/
https://www.ncbi.nlm.nih.gov/pubmed/32726951
http://dx.doi.org/10.3390/jcm9082392
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author Lee, Keum Hwa
Yoon, Sojung
Jeong, Gwang Hun
Kim, Jong Yeob
Han, Young Joo
Hong, Sung Hwi
Ryu, Seohyun
Kim, Jae Seok
Lee, Jun Young
Yang, Jae Won
Lee, Jinhee
Solmi, Marco
Koyanagi, Ai
Dragioti, Elena
Jacob, Louis
Radua, Joaquim
Smith, Lee
Oh, Hans
Tizaoui, Kalthoum
Cargnin, Sarah
Terrazzino, Salvatore
Ghayda, Ramy Abou
Kronbichler, Andreas
Shin, Jae Il
author_facet Lee, Keum Hwa
Yoon, Sojung
Jeong, Gwang Hun
Kim, Jong Yeob
Han, Young Joo
Hong, Sung Hwi
Ryu, Seohyun
Kim, Jae Seok
Lee, Jun Young
Yang, Jae Won
Lee, Jinhee
Solmi, Marco
Koyanagi, Ai
Dragioti, Elena
Jacob, Louis
Radua, Joaquim
Smith, Lee
Oh, Hans
Tizaoui, Kalthoum
Cargnin, Sarah
Terrazzino, Salvatore
Ghayda, Ramy Abou
Kronbichler, Andreas
Shin, Jae Il
author_sort Lee, Keum Hwa
collection PubMed
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, p = 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, p < 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, p < 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.
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spelling pubmed-74659452020-09-04 Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis Lee, Keum Hwa Yoon, Sojung Jeong, Gwang Hun Kim, Jong Yeob Han, Young Joo Hong, Sung Hwi Ryu, Seohyun Kim, Jae Seok Lee, Jun Young Yang, Jae Won Lee, Jinhee Solmi, Marco Koyanagi, Ai Dragioti, Elena Jacob, Louis Radua, Joaquim Smith, Lee Oh, Hans Tizaoui, Kalthoum Cargnin, Sarah Terrazzino, Salvatore Ghayda, Ramy Abou Kronbichler, Andreas Shin, Jae Il J Clin Med Article (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, p = 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, p < 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, p < 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. MDPI 2020-07-27 /pmc/articles/PMC7465945/ /pubmed/32726951 http://dx.doi.org/10.3390/jcm9082392 Text en © 2020 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Lee, Keum Hwa
Yoon, Sojung
Jeong, Gwang Hun
Kim, Jong Yeob
Han, Young Joo
Hong, Sung Hwi
Ryu, Seohyun
Kim, Jae Seok
Lee, Jun Young
Yang, Jae Won
Lee, Jinhee
Solmi, Marco
Koyanagi, Ai
Dragioti, Elena
Jacob, Louis
Radua, Joaquim
Smith, Lee
Oh, Hans
Tizaoui, Kalthoum
Cargnin, Sarah
Terrazzino, Salvatore
Ghayda, Ramy Abou
Kronbichler, Andreas
Shin, Jae Il
Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis
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 Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7465945/
https://www.ncbi.nlm.nih.gov/pubmed/32726951
http://dx.doi.org/10.3390/jcm9082392
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