(37) Efficacy and Safety of Corticosteroids in COVID-19: An Overview of Meta-Analyses

Saturday, August 27, 2022

8:00 AM – 6:00 PM CEST

Location: Hall C

Publication Number: 711

Presenting Author(s)

Sreedharan Nair, MPharm, PhD, PhD
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Udupi, Karnataka, India

Co-Author(s)

Muhammed Rashid, MPharm, BPharm
– Research Scholar, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Udupi, Karnataka, India
Asha K. Rajan, PharmD
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education , CHENNAI, Tamil Nadu, India
Ambalappotta Hafis
– PharmD Intern, Manipal College of Pharmacuetical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Viji Chandran
– Research scholar, Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Karnataka, India
Girish Thunga
– Manipal College of Pharmaceutical Sciences, Manipal Academy of Higher Education, Manipal, Manipal, Karnataka, India
Vishal Shanbhag
– Department of Critical Care, Kasturba Hospital, Manipal, Karnataka, India
Souvik Chaudhuri
– Associate Professor, Kasturba Medical College, Manipal Academy of Higher Education, Manipal, Karnataka, India

Background: Evidence-based recommendations on the efficacy and safety of corticosteroids in COVID-19 are still inconclusive.

Objectives: We aimed to assess the published meta-analyses and provide further insight into the current uncertainty.

Methods: PubMed/MEDLINE, SCOPUS, Cochrane, and Embase from inception to December 2021 were accessed. Mortality, ICU and ventilator outcomes, viral clearance, and adverse events were the outcome of interest. The review also assessed meta-analysis design-related outcomes which include the quality of meta-analysis, factors contributing to the risk of bias, extent, sources of heterogeneity, publication bias, and robustness of findings.

Results: A total of 49 meta-analyses out of 5426 records were reviewed. There was inconsistent evidence with respect to the mortality benefit from steroid management, with 15 and 18 studies reporting a significant reduction and non-significant effect, respectively. In terms of ICU and ventilator outcomes, the steroid group had significantly better outcomes than the control group. Similarly, hospital stay was significantly longer in the steroid group compared to the control group. There was a non-significant difference in viral clearance and occurrence of adverse events in both groups. Substantial heterogeneity was observed in the majority of the analyses and various factors contributed to it.

Conclusions: Corticosteroid therapy was effective in terms of ICU and ventilator outcomes with minimal safety concerns in COVID-19 patients. Despite this, there is some disagreement over the mortality outcome.