Corticosteroids

corticotherapy lowered the risk of intubation with a risk difference of -47.1%

Furosemide was co-administered. Significantly decreased primary outcome in the corticosteroid-treated patients (efficacy was significant in the patient subgroup with elevated serum brain natriuretic peptide levels). Sample size: 26 + 93 control. Dosage: 1.25u202fmg/kg/24u202fh prednisolone equivalent for 4 days. Endpoint: Invasive mechanical ventilation requirement or 28-day mortality (primary outcome).

Significant reduction of primary outcome and in the individual components of the primary outcome in non-ICU patients. Sample size: 60 + 145 control. Dosage: Median or equivalent dose of 80 mg per day (IQR, 60–107) of methylprednisolone (equivalent to 12 (IQR, 9–16) mg of dexamethasone) for a median duration of 5 days (IQR, 4–7). Endpoint: The composite of ICU transfer, intubation, or in-hospital mortality (primary outcome).

No significant difference in the primary outcome. Within a subgroup analysis, corticoid treatment in patients with PO2/FiO2 < 200 mm Hg at admission had statistically significant decrease in 30-day mortality. Sample size: 170 + 343 control. Dosage: ≥0.5 mg/kg of prednisone equivalent. Endpoint: 30-day mortality from hospital admission (primary).

Significantly decreased mortality or ICU admission. In subgroup analyses the difference was significant for patients requiring high-flow oxygen or non-invasive mechanical ventilation but insignificant in patients requiring low-flow oxygen therapy only. No significant difference in the time to clinical improvement was observed between the treatment and the control group. Sample size: 38 + 77 control. Dosage: Methylprednisolone 250 mg first dose and then 40 mg twice daily for 4 days or dexamethasone 20 mg daily for 5 days and then 10 mg daily for 5 or more days.

No negative impact on antibody response and viral clearance detected. Sample size: 27 + 50 control. Dosage: Daily pulses of 250–500u202fmg during 3 days.

Low dose of corticosteroids in ARDS patients was associated with reduced risk of primary outcome without significant difference in the secondary. Positive effect was supported by a decrease in CRP levels in the treatment group. Sample size: 226 + 156 control. Dosage: 80 mg of methylprednisolone equivalent daily dose (maximum) for 7 days (median). Endpoints: 60-day in-hospital mortality (primary); time to SARS-CoV-2 viral clearance (secondary).

Significant improvement in PaO2: FiO2 ratio in COVID-19 ARDS patients after corticosteroid treatment (but not in non-COVID-19 ARDS patients). Sample size: 16 COVID-19 ARDS + 32 non-COVID-19 ARDS. Dosage: 1–2 mg/kg daily methylprednisolone or 50–100 mg four times a day cortisol.

Improvement in oxygenation (assessed in a short term). Sample size: 38 + 29 control. Dosage: Drugs administered during the course of 8 days in average.

Among the ICU patients treated with corticosteroids within 48 hours of ICU admission (“early group”) there was a lower incidence of organ disfunction, renal replacement therapy need, and systemic inflammation compared to patients with delayed treatment. The early group had significantly lower mortality rate and higher improvement in some clinical parameters compared to non-early group patients. Within the early group, moderate-to-high dosing resulted in better outcome. Sample size: 485 (early corticosteroids) + 206 (delayed corticosteroids) + 191 (no corticosteroids). Dosage: Methylprednisolone <1 mg/kg/d or dexamethasone <0.12 mg/kg/d or prednisone <0.5 mg/kg/d ("low dose") or "high dose" for any values higher than those listed. Endpoint: ICU mortality (primary).

High-dose corticosteroid pulses in patients in danger of hyper-inflammatory response increased the survival rate. Sample size: 64 + 254 control. Dosage: ≥1.5 mg/kg/24h of methylprednisolone or dexamethasone equivalent for 3 days (up to 5 days in patients who did not improve; 2 days in 2 patiens with rapid improvement).

Statistically significant reduction of mortality was observed in corticosteroid-treated severe but not non-severe patients, compared to control. In severe patients corticosteroid treatment shortened the duration of fever and did not lead to a significant increase in the length of hospital stay. Sample size: 79 non-severe + 196 non-severe control; 178 severe + 90 severe control. Dosage: A median of 40 mg of methylprednisolone equivalent daily for a median of 6 or 8 days in non-severe and severe patients, respectively.

Although significantly more patients who received corticosteroid therapy died, the therapy was not significantly associated with 28-day mortality after marginal structural modelling. The subgroup of patients in hyperinflammatory state, as defined by proinflammatory cytokine levels, higher SOFA scores, and complication rates, significantly benefitted from corticosteroid therapy from the 28-day mortality standpoint. Sample size: 280 + 148 control. Dosage: Most patients received methylprednisolone. The initial and maximal daily methylprednisolone-equivalent doses were 40 mg (median). The median duration of therapy was 6.5 days.

Statistically significantly better overall survival by day 14 was observed among elderly patients with COVID-19 pneumonia requiring supplementary oxygen therapy who received corticosteroid treatment compared to those who did not. Sample size: 98 + 166 control. Dosage: ≥0.4 mg/kg daily of prednisone equivalent for at least one day. Primary outcome: Overall survival by day 14.

Early administration of the drug statistically significantly reduced the likelihood of urgent medical attention need and reduced time to recovery. Sample size: 69 + 70 control. Dosage: Inhaled 800 μg twice a day until symptom resolution. Primary endpoint: COVID-19-related urgent care visit.

Cytokine storm COVID-19 patients treated using corticosteroids (CS) together with tocilizumab showed lower mortality compared to those treated using CS alone or CS in combination with anakinra. Sample size: 1,383 CS only + 454 CS and tocilizumab + 733 CS and anakinra + 73 tocilizumab only + 57 anakinra only + 3,076 standard of care. Main outcome: Hospital mortality

Corticosteroids decreased the risk of invasive mechanical ventilation. Sample size: 97 out of 382 (the whole assessed cohort). 

Based on observations of paediatric patients suffering from multisystem inflammatory syndrome, the authors state that anakinra and corticosteroids seem to be effective and safe. Sample size: 26.