Corticosteroid therapy for COVID-19: A systematic review and meta-analysis of randomized controlled trials

COVID-19에 대한 코르티코스테로이드 요법: 무작위 대조 시험의 체계적인 검토 및 메타 분석

Published on
Journal: Medicine
[저자] Yashwitha Sai Pulakurthi, John M Pederson, Kavitha Saravu, Nitin Gupta, Prasanth Balasubramanian, Shelby Kamrowski, Megan Schmidt, Charan Thej Reddy Vegivinti, Mahmoud Dibas, Natalie L Reierson, Sailaja Pisipati, Betsy Ann Joseph, Pragadeesh Thamarai Selvan, Adam A Dmytriw, Praneeth Reddy Keesari, Varsha Sriram, Spandana Chittajallu, Waleed Brinjikji, Rewanth R Katamreddy, Richa Chibbar, Amber R Davis, Manashree Malpe, Hemant K Mishra, Kevin M Kallmes, Ameer E Hassan, Kirk W Evanson
[Category] SARS, 임상,
PMC URL    [DOI] 10.1097/MD.0000000000025719    
[Article Type] Meta-Analysis
[Source] PMC

Abstract
Background: Corticosteroid treatment is an effective and common therapeutic strategy for various inflammatory lung pathologies and may be an effective treatment for coronavirus disease 2019 (COVID-19). The purpose of this systematic review and meta-analysis of current literature was to investigate the clinical outcomes associated with corticosteroid treatment of COVID-19.
Methods: We systematically searched PubMed, medRxiv, Web of Science, and Scopus databases through March 10, 2021 to identify randomized controlled trials (RCTs) that evaluated the effects of corticosteroid therapies for COVID-19 treatment. Outcomes of interest were mortality, need for mechanical ventilation, serious adverse events (SAEs), and superinfection.
Results: A total of 7737 patients from 8 RCTs were included in the quantitative meta-analysis, of which 2795 (36.1%) patients received corticosteroids plus standard of care (SOC) while 4942 (63.9%) patients received placebo and/or SOC alone. The odds of mortality were significantly lower in patients that received corticosteroids as compared to SOC (odds ratio [OR] = 0.85 [95% CI: 0.76; 0.95], P = .003). Corticosteroid treatment reduced the odds of a need for mechanical ventilation as compared to SOC (OR = 0.76 [95% CI: 0.59; 0.97], P = .030). There was no significant difference between the corticosteroid and SOC groups with regards to SAEs and superinfections.
Conclusion: Corticosteroid treatment can reduce the odds for mortality and the need for mechanical ventilation in severe COVID-19 patients.

All Keywords
【초록키워드】 Corticosteroid, COVID-19, Randomized controlled trial, Treatment, coronavirus disease, Meta-analysis, Coronavirus disease 2019, Corticosteroids, Randomized controlled trials, Mortality, mechanical ventilation, systematic review, database, RCT, clinical outcomes, Clinical outcome, COVID-19 treatment, Patient, Placebo, superinfection, group, Quantitative, therapeutic strategy, Lung pathology, RCTs, Inflammatory, Odds ratio, Standard of care, Serious Adverse Events, Serious Adverse Event, Web of Science, significant difference, no significant difference, severe COVID-19 patients, SAEs, corticosteroid therapy, significantly lower, corticosteroid treatment, Effect, effective, identify, evaluated, reduced, searched, reduce, SAE, 【제목키워드】 Randomized controlled trial, Meta-analysis, therapy, systematic review,
{{{ 추상적인 }}} {{ 배경: }} 코르티코스테로이드 치료는 다양한 염증성 폐 병리에 대한 효과적이고 일반적인 치료 전략이며 코로나바이러스 2019(COVID-19)에 대한 효과적인 치료법이 될 수 있습니다. 현재 문헌에 대한 이 체계적인 검토 및 메타 분석의 목적은 COVID-19의 코르티코스테로이드 치료와 관련된 임상 결과를 조사하는 것이었습니다. {{ 방법: }} 우리는 2021년 3월 10일까지 PubMed, medRxiv, Web of Science, Scopus 데이터베이스를 체계적으로 검색하여 COVID-19 치료에 대한 코르티코스테로이드 요법의 효과를 평가한 무작위 대조 시험(RCT)을 확인했습니다. 관심 결과는 사망률, 기계적 환기의 필요성, 심각한 부작용(SAE) 및 중복 감염이었습니다. {{ 결과: }} 8건의 RCT에서 총 7,737명의 환자가 정량적 메타 분석에 포함되었으며, 그 중 2,795명(36.1%)의 환자가 코르티코스테로이드와 표준 치료(SOC)를 받았고 4,942명(63.9%)의 환자가 위약과 /또는 SOC 단독. 사망 확률은 SOC에 비해 코르티코스테로이드를 투여받은 환자에서 유의하게 낮았습니다(교차비 [OR] = 0.85 [95% CI: 0.76; 0.95], P = .003). 코르티코스테로이드 치료는 SOC와 비교하여 기계적 환기의 필요성을 감소시켰습니다(OR = 0.76 [95% CI: 0.59; 0.97], P = .030). SAE 및 중복 감염과 관련하여 코르티코스테로이드 그룹과 SOC 그룹 간에는 유의한 차이가 없었습니다. {{ 결론: }} 코르티코스테로이드 치료는 중증 코로나19 환자의 사망률과 기계적 환기의 필요성을 줄일 수 있습니다.