Safety and efficacy of glucocorticoids in the treatment of COVID-19: A meta-analysis of randomized control trials.

IF 2.9 3区医学 Q2 RESPIRATORY SYSTEM

Expert Review of Respiratory Medicine Pub Date : 2023-01-01 DOI:10.1080/17476348.2023.2177155

Wenxiao Qiao, Lihong Meng, Ye Zhang, Dian Li, Jingjing Chen, Jinyun Wang, Di Xie, Xiaoming Xue

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引用次数: 2

Abstract

Background: It is unclear the efficacy and safety of glucocorticoids compared with placebo or usual care for treatment of COVID-19.

Research design and methods: Randomized controlled trials (RCTs) of corticosteroids in COVID-19 patients from 1 December 2019, to 30 June 2022, were assessed using Cochrane bias risk assessment method and improved Jadad score scale. GRADEpro was used to rate the quality of evidence for outcomes.

Results: Fifteen RCTs were included, including 10,620 patients. Glucocorticoid treatment for severe and critical COVID-19 showed lesser all-cause mortality (OR = 0.85, 95% CI [0.76, 0.94], P = 0.002) than conventional treatment. However, for mildly ill patients, neither inhaled drugs nor intravenous drugs reduced mortality (OR = 0.64, 95% CI [0.24, 1.76], P = 0.39). Glucocorticoids had no significant effect on the adverse reactions of patients (OR = 1.18, 95% CI [0.77, 1.80], P = 0.44) compared with usual care/placebo. Subgroup analysis demonstrated that dexamethasone significantly reduced the mortality of COVID-19 patients. Low-dose glucocorticoids were also associated with lower all-cause mortality.

Conclusion: Glucocorticoids (especially dexamethasone) reduce mortality of patients with severe and critical COVID-19 with no significant effect on the incidence of adverse reactions (moderate quality). In contrast, glucocorticoids do not benefit patients with mild symptoms (low quality).

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糖皮质激素治疗COVID-19的安全性和有效性:随机对照试验的荟萃分析

背景:与安慰剂或常规护理相比，糖皮质激素治疗COVID-19的疗效和安全性尚不清楚。研究设计与方法:采用Cochrane偏倚风险评估法和改进的Jadad评分量表，对2019年12月1日至2022年6月30日COVID-19患者中皮质类固醇的随机对照试验(rct)进行评估。GRADEpro用于评价结果证据的质量。结果:纳入15项随机对照试验，共10620例患者。糖皮质激素治疗重症和危重型COVID-19的全因死亡率低于常规治疗(OR = 0.85, 95% CI [0.76, 0.94]， P = 0.002)。然而，对于病情较轻的患者，吸入药物和静脉注射药物均不能降低死亡率(OR = 0.64, 95% CI [0.24, 1.76]， P = 0.39)。与常规护理/安慰剂相比，糖皮质激素对患者不良反应无显著影响(OR = 1.18, 95% CI [0.77, 1.80]， P = 0.44)。亚组分析显示，地塞米松可显著降低COVID-19患者的死亡率。低剂量糖皮质激素也与较低的全因死亡率相关。结论:糖皮质激素(尤其是地塞米松)可降低重症、危重型COVID-19患者的死亡率，对不良反应(中度)发生率无显著影响。相比之下，糖皮质激素对症状轻微(低质量)的患者无效。

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来源期刊

Expert Review of Respiratory Medicine RESPIRATORY SYSTEM-

CiteScore

6.80

自引率

2.60%

发文量

期刊介绍： Coverage will include the following key areas: - Prospects for new and emerging therapeutics - Epidemiology of disease - Preventive strategies - All aspects of COPD, from patient self-management to systemic effects of the disease and comorbidities - Improved diagnostic methods, including imaging techniques, biomarkers and physiological tests. - Advances in the treatment of respiratory infections and drug resistance issues - Occupational and environmental factors - Progress in smoking intervention and cessation methods - Disease and treatment issues for defined populations, such as children and the elderly - Respiratory intensive and critical care - Updates on the status and advances of specific disease areas, including asthma, HIV/AIDS-related disease, cystic fibrosis, COPD and sleep-disordered breathing morbidity