Association between glucocorticoids treatment and viral clearance delay in patients with COVID-19: a systematic review and meta-analysis

BACKGROUND: Evidence of glucocorticoids on viral clearance delay of COVID-19 patients is not clear. METHODS: In this systematic review and meta-analysis, we searched for studies on Medline, Embase, EBSCO, ScienceDirect, Web of Science, Cochrane Library, and ClinicalTrials.gov from 2019 to April 20, 2021. We mainly pooled the risk ratios (RRs) and mean difference (MD) for viral clearance delay and did subgroup analyses by the severity of illness and doses of glucocorticoids. RESULTS: 38 studies with a total of 9572 patients were identified. Glucocorticoids treatment was associated with delayed viral clearance in COVID-19 patients (adjusted RR 1.52, 95% CI 1.29 to 1.80, I(2) = 52%), based on moderate-quality evidence. In subgroup analyses, risk of viral clearance delay was significant both for COVID-19 patients being mild or moderate ill (adjusted RR 1.86, 95% CI 1.35 to 2.57, I(2) = 48%), and for patients of being severe or critical ill (adjusted RR 1.59, 95% CI 1.23 to 2.07, I(2) = 0%); however, this risk significantly increased for patients taking high doses (unadjusted RR 1.85, 95% CI 1.08 to 3.18; MD 7.19, 95% CI 2.78 to 11.61) or medium doses (adjusted RR 1.86, 95% CI 0.96 to 3.62, I(2) = 45%; MD 3.98, 95% CI 3.07 to 4.88, I(2) = 4%), rather those taking low doses (adjusted RR 1.38, 95% CI 0.94 to 2.02, I(2) = 59%; MD 1.46, 95% CI −0.79 to 3.70, I(2) = 82%). CONCLUSIONS: Glucocorticoids treatment delayed viral clearance in COVID-19 patients of taking high doses or medium doses, rather in those of taking low doses of glucocorticoids. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12879-021-06548-z.