Role of corticosteroid in the management of COVID-19: A systemic review and a Clinician's perspective

Diabetes Metab Syndr. Sep-Oct 2020;14(5):971-978. doi: 10.1016/j.dsx.2020.06.054. Epub 2020 Jun 27.

Abstract

Background and aims: Interest in corticosteroid therapy in COVID-19 has been rekindled after the results from Randomized Evaluation of COVid-19 thERapY (RECOVERY) Trial. However, the World health Organization has not recommended corticosteroid in the treatment of COVID-19. We sought to conduct a systematic review on the role of corticosteroid in the management of patients of COVID-19.

Methods: A systematic electronic search of PubMed, Cochrane and MedRxiv database using specific keywords was made up till June 17, 2020. Full text of all the original articles with supplementary appendix that fulfilled the inclusion criteria were retrieved and a detailed analysis of results were represented.

Results: Of the 5 studies (4 retrospective studies and 1 quasi-prospective study) conducted for evaluating the role of corticosteroids, 3 studies have shown benefit, while 2 studies shown no benefit and there was a suggestion of significant harm in critical cases in one sub-study. RECOVERY trial is the only randomized controlled trial that has shown a significant reduction of death by 35% in ventilated patients and by 20% amongst patients on supplemental oxygen therapy with the dexamethasone, although no benefit was observed in mild cases.

Conclusions: While the results from retrospective studies are heterogenous and difficult to infer of a definitive protective benefit with corticosteroids, RECOVERY trial found a significantly better outcome with dexamethasone, mostly in severe cases. Nonetheless, more studies are needed to replicate the outcome shown in RECOVERY trial for a substantial conclusion.

Keywords: ARDS; COVID-19; Corticosteroids; Dexamethasone; Methylprednisolone; SARS-CoV-2.

Publication types

  • Systematic Review

MeSH terms

  • Adrenal Cortex Hormones / therapeutic use*
  • Betacoronavirus / drug effects*
  • Betacoronavirus / isolation & purification
  • Clinical Trials as Topic
  • Coronavirus Infections / drug therapy*
  • Coronavirus Infections / epidemiology
  • Coronavirus Infections / virology
  • Disease Management
  • Humans
  • India / epidemiology
  • Pandemics
  • Pneumonia, Viral / drug therapy*
  • Pneumonia, Viral / epidemiology
  • Pneumonia, Viral / virology
  • Prospective Studies
  • Retrospective Studies

Substances

  • Adrenal Cortex Hormones

Supplementary concepts

  • COVID-19
  • severe acute respiratory syndrome coronavirus 2