Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis.
Por:
Lee KH, Yoon S, Jeong GH, Kim JY, Han YJ, Hong SH, Ryu S, Kim JS, Lee JY, Yang JW, Lee J, Solmi M, Koyanagi A, Dragioti E, Jacob L, Radua J, Smith L, Hans Oh, Tizaoui K, Cargnin S, Terrazzino S, Ghayda RA, Kronbichler A and Shin JI
Publicada:
27 jul 2020
Ahead of Print:
27 jul 2020
Categoría:
Medicine (miscellaneous)
Resumen:
(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.
Filiaciones:
Lee KH:
Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
Yoon S:
Yonsei University College of Medicine, Seoul 03722, Korea
Jeong GH:
College of Medicine, Gyeongsang National University, Jinju 52727, Korea
Kim JY:
Yonsei University College of Medicine, Seoul 03722, Korea
Han YJ:
Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
Hong SH:
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
Ryu S:
Yonsei University College of Medicine, Seoul 03722, Korea
Kim JS:
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
Lee JY:
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
Yang JW:
Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
Lee J:
Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
Solmi M:
Department of Neuroscience, University of Padova, 35121 Padova, Italy
Koyanagi A:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
Dragioti E:
Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linköping University, SE-581 85 Linköping, Sweden
Jacob L:
Research and Development Unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
Radua J:
Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
Mental Health Research Networking Center (CIBERSAM), 08036 Barcelona, Spain
Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London SE5 8AF, UK
Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, 11330 Stockholm, Sweden
Smith L:
The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK
Hans Oh:
School of Social Work, University of Southern California, Los Angeles, CA 90015, USA
Tizaoui K:
Department of Basic Sciences, Division of Histology and Immunology, Faculty of Medicine Tunis, Tunis El Manar University, Tunis 1068, Tunisia
Cargnin S:
Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100 Novara, Italy
Terrazzino S:
Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100 Novara, Italy
Ghayda RA:
Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
Division of Urology, Brigham and Women's Hospital and Harvard Medical School, Boston, MA 02115, USA
Kronbichler A:
Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria
Shin JI:
Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
Green Published, Green Accepted, gold
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