The roles of methylprednisolone treatment in patients with COVID-19: A systematic review and meta-analysis

The roles of methylprednisolone in treatment of patients with COVID-19 remain unclear. The aim of this study was to evaluate the efficacy and safety of methylprednisolone in treatment of COVID-19 patients. PubMed, Cochrane and Web of Science were searched for studies comparing methylprednisolone and no glucocorticoids treatment in patients with COVID-19. Statistical pooling was reported as risk ratio (RR) or mean difference (MD) with corresponding 95 % confidence interval (CI). Thirty-three studies were eligible, including 5 randomized trials and 28 observational studies. Meta-analysis showed that compared with no glucocorticoids, methylprednisolone in treatment of COVID-19 patients was associated with reduced short-term mortality (RR 0.73; 95% CI 0.60–0.89), less need for ICU admission (RR 0.77; 95% CI 0.66–0.91) and mechanical ventilation (RR 0.69; 95% CI 0.57–0.84), increased 28-day ventilator-free days (MD 2.81; 95% CI 2.64–2.97), without increasing risk of secondary infections (RR 1.04; 95% CI 0.82–1.32), but could prolong duration of viral shedding (MD 1.03; 95% CI 0.25–1.82). Subgroup analyses revealed that low-dose (≤2mg/kg/day) methylprednisolone treatment for ≤ 7 days in severe COVID-19 patients was associated with relatively better clinical outcomes, without increasing duration of viral shedding. Compared with no glucocorticoids, methylprednisolone treatment in COVID-19 patients is associated with reduced short-term mortality and better clinical outcomes, without increasing secondary infections, but could slightly prolong duration of viral shedding. Patients with severe COVID-19 are more likely to benefit from short-term low-dose methylprednisolone treatment (1–2 mg/kg/day for ≤ 7 days).