Journal
STEROIDS
Volume 183, Issue -, Pages -Publisher
ELSEVIER SCIENCE INC
DOI: 10.1016/j.steroids.2022.109022
Keywords
Methylprednisolone; Glucocorticoids; Treatment; COVID-19; Meta-analysis; Methylprednisolone; Glucocorticoids; Treatment; COVID-19; Meta-analysis
Funding
- Medicine and Health Science Technology Development Plan Project of Shandong Province [2019WS042]
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This study aimed to evaluate the efficacy and safety of methylprednisolone in the treatment of COVID-19 patients. The meta-analysis showed that methylprednisolone treatment is associated with reduced short-term mortality and better clinical outcomes, without increasing the risk of secondary infections, but could slightly prolong the duration of viral shedding.
The roles of methylprednisolone in treatment of patients with COVID-19 remain unclear. The aim of this study was to evaluate the efficacy and safety of methylprednisolone in treatment of COVID-19 patients. PubMed, Cochrane and Web of Science were searched for studies comparing methylprednisolone and no glucocorticoids treatment in patients with COVID-19. Statistical pooling was reported as risk ratio (RR) or mean difference (MD) with corresponding 95 % confidence interval (CI). Thirty-three studies were eligible, including 5 randomized trials and 28 observational studies. Meta-analysis showed that compared with no glucocorticoids, methylprednisolone in treatment of COVID-19 patients was associated with reduced short-term mortality (RR 0.73; 95% CI 0.60-0.89), less need for ICU admission (RR 0.77; 95% CI 0.66-0.91) and mechanical ventilation (RR 0.69; 95% CI 0.57-0.84), increased 28-day ventilator-free days (MD 2.81; 95% CI 2.64-2.97), without increasing risk of secondary infections (RR 1.04; 95% CI 0.82-1.32), but could prolong duration of viral shedding (MD 1.03; 95% CI 0.25-1.82). Subgroup analyses revealed that low-dose (<2mg/kg/day) methylprednisolone treatment for < 7 days in severe COVID-19 patients was associated with relatively better clinical outcomes, without increasing duration of viral shedding. Compared with no glucocorticoids, methylprednisolone treatment in COVID-19 patients is associated with reduced short-term mortality and better clinical outcomes, without increasing secondary infections, but could slightly prolong duration of viral shedding. Patients with severe COVID-19 are more likely to benefit from short-term low-dose methylprednisolone treatment (1-2 mg/kg/day for < 7 days).
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