With input from Dr Monica Vasudev

1075:  Meta-analysis finds corticosteroids reduce risk of death in critically ill COVID-19 patients

DG Alerts excerpts: A meta-analysis published in the Journal of the American Medical Association suggested that the use of systemic corticosteroids in critically ill patients with COVID-19 was tied to lower 28-day all-cause mortality compared to usual care or placebo. The benefit was the same irrespective of age, sex or the duration of illness.

Among the participants, 678 patients had been randomized to receive systemic dexamethasone, hydrocortisone or methylprednisolone; remaining 1025 patients received usual care or placebo. The median age was 60 years, and 29% were women. The primary outcome was all-cause mortality up to 30 days following randomization and was determined before any outcome data were available from any of the studies.

There were 222 deaths among the corticosteroid-treated patients and 425 deaths among those receiving usual care or placebo, corresponding to an absolute mortality risk of 32% with corticosteroids compared with an assumed mortality risk of 40% with usual care or placebo.

Among the six trials reporting serious adverse events, 64 events occurred among 354 patients given corticosteroids and 80 events occurred among 342 patients who received usual care or placebo.

The findings are in contrast with outcomes reported for the administration of corticosteroids among patients with influenza, where mortality and hospital-acquired infections may be increased by the administration of corticosteroids.

The ORs for the association between corticosteroids and mortality appeared to be similar for older and younger individuals, men and women, and for longer and shorter durations of symptoms before randomization.

This analysis was hastened owing to the release of results from the RECOVERY trial, which noted that the absolute risk of death was reduced by 12.1% among those administered low-dose dexamethasone who were receiving invasive mechanical ventilation at randomization.

The optimal dose and duration of treatment could not be assessed in the present analysis. There was no evidence to suggest that a higher dose of corticosteroids was associated with greater benefit than a lower dose.

Dr KK Aggarwal

President CMAAO, HCFI and Past National President IMA