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Article

Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis

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Department of Pediatrics, Yonsei University College of Medicine, Seoul 03722, Korea
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Yonsei University College of Medicine, Seoul 03722, Korea
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College of Medicine, Gyeongsang National University, Jinju 52727, Korea
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Department of Pediatrics, Samsung Changwon Hospital, Sungkyunkwan University School of Medicine, Changwon 51353, Korea
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Department of Global Health and Population, Harvard T.H. Chan School of Public Health, 677 Huntington Avenue, Boston, MA 02115, USA
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Department of Nephrology, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
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Department of Psychiatry, Yonsei University Wonju College of Medicine, Wonju 26426, Korea
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Department of Neuroscience, University of Padova, 35121 Padova, Italy
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Research and development unit, Parc Sanitari Sant Joan de Déu, CIBERSAM, Dr. Antoni Pujadas, 42, Sant Boi de Llobregat, 08830 Barcelona, Spain
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ICREA, Pg. Lluis Companys 23, 08010 Barcelona, Spain
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Pain and Rehabilitation Centre, and Department of Health, Medicine and Caring Sciences, Linkoping University, SE-581 85 Linkoping, Sweden
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Faculty of Medicine, University of Versailles Saint-Quentin-en-Yvelines, 78180 Montigny-le-Bretonneux, France
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Institut d’Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), 08036 Barcelona, Spain
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Mental Health Research Networking Center (CIBERSAM), 08036 Barcelona, Spain
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Department of Psychosis Studies, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London SE5 8AF, UK
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Centre for Psychiatric Research, Department of Clinical Neuroscience, Karolinska Institutet, 11330 Stockholm, Sweden
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The Cambridge Centre for Sport and Exercise Sciences, Anglia Ruskin University, Cambridge CB1 1PT, UK
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School of Social Work, University of Southern California, Los Angeles, CA 90015, USA
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Department of Basic Sciences, Division of Histology and Immunology, Faculty of Medicine Tunis, Tunis El Manar University, Tunis 1068, Tunisia
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Department of Pharmaceutical Sciences and Interdepartmental Research Center of Pharmacogenetics and Pharmacogenomics (CRIFF), University of Piemonte Orientale, 28100 Novara, Italy
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Division of Urology, Brigham and Women’s Hospital and Harvard Medical School, Boston, MA 02115, USA
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Department of Internal Medicine IV (Nephrology and Hypertension), Medical University Innsbruck, 6020 Innsbruck, Austria
*
Author to whom correspondence should be addressed.
J. Clin. Med. 2020, 9(8), 2392; https://doi.org/10.3390/jcm9082392
Received: 17 May 2020 / Revised: 27 June 2020 / Accepted: 29 June 2020 / Published: 27 July 2020
(This article belongs to the Section Infectious Diseases)
(1) Background: The use of corticosteroids in critical coronavirus infections, including severe acute respiratory syndrome (SARS), Middle East Respiratory Syndrome (MERS), or Coronavirus disease 2019 (COVID-19), has been controversial. However, a meta-analysis on the efficacy of steroids in treating these coronavirus infections is lacking. (2) Purpose: We assessed a methodological criticism on the quality of previous published meta-analyses and the risk of misleading conclusions with important therapeutic consequences. We also examined the evidence of the efficacy of corticosteroids in reducing mortality in SARS, MERS and COVID-19. (3) Methods: PubMed, MEDLINE, Embase, and Web of Science were used to identify studies published until 25 April 2020, that reported associations between steroid use and mortality in treating SARS/MERS/COVID-19. Two investigators screened and extracted data independently. Searches were restricted to studies on humans, and articles that did not report the exact number of patients in each group or data on mortality were excluded. We calculated odds ratios (ORs) or hazard ratios (HRs) under the fixed- and random-effect model. (4) Results: Eight articles (4051 patients) were eligible for inclusion. Among these selected studies, 3416 patients were diagnosed with SARS, 360 patients with MERS, and 275 with COVID-19; 60.3% patients were administered steroids. The meta-analyses including all studies showed no differences overall in terms of mortality (OR 1.152, 95% CI 0.631–2.101 in the random effects model, p = 0.645). However, this conclusion might be biased, because, in some studies, the patients in the steroid group had more severe symptoms than those in the control group. In contrast, when the meta-analysis was performed restricting only to studies that used appropriate adjustment (e.g., time, disease severity), there was a significant difference between the two groups (HR 0.378, 95% CI 0.221–0.646 in the random effects model, p < 0.0001). Although there was no difference in mortality when steroids were used in severe cases, there was a difference among the group with more underlying diseases (OR 3.133, 95% CI 1.670–5.877, p < 0.001). (5) Conclusions: To our knowledge, this study is the first comprehensive systematic review and meta-analysis providing the most accurate evidence on the effect of steroids in coronavirus infections. If not contraindicated, and in the absence of side effects, the use of steroids should be considered in coronavirus infection including COVID-19. View Full-Text
Keywords: corticosteroids; coronavirus; severe acute respiratory syndrome (SARS); Middle East respiratory syndrome (MERS); coronavirus disease 2019 (COVID-19) corticosteroids; coronavirus; severe acute respiratory syndrome (SARS); Middle East respiratory syndrome (MERS); coronavirus disease 2019 (COVID-19)
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Figure 1

MDPI and ACS Style

Lee, K.H.; Yoon, S.; Jeong, G.H.; Kim, J.Y.; Han, Y.J.; Hong, S.H.; Ryu, S.; Kim, J.S.; Lee, J.Y.; Yang, J.W.; Lee, J.; Solmi, M.; Koyanagi, A.; Dragioti, E.; Jacob, L.; Radua, J.; Smith, L.; Oh, H.; Tizaoui, K.; Cargnin, S.; Terrazzino, S.; Ghayda, R.A.; Kronbichler, A.; Shin, J.I. Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis. J. Clin. Med. 2020, 9, 2392. https://doi.org/10.3390/jcm9082392

AMA Style

Lee KH, Yoon S, Jeong GH, Kim JY, Han YJ, Hong SH, Ryu S, Kim JS, Lee JY, Yang JW, Lee J, Solmi M, Koyanagi A, Dragioti E, Jacob L, Radua J, Smith L, Oh H, Tizaoui K, Cargnin S, Terrazzino S, Ghayda RA, Kronbichler A, Shin JI. Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis. Journal of Clinical Medicine. 2020; 9(8):2392. https://doi.org/10.3390/jcm9082392

Chicago/Turabian Style

Lee, Keum H., Sojung Yoon, Gwang H. Jeong, Jong Y. Kim, Young J. Han, Sung H. Hong, Seohyun Ryu, Jae S. Kim, Jun Y. Lee, Jae W. Yang, Jinhee Lee, Marco Solmi, Ai Koyanagi, Elena Dragioti, Louis Jacob, Joaquim Radua, Lee Smith, Hans Oh, Kalthoum Tizaoui, Sarah Cargnin, Salvatore Terrazzino, Ramy A. Ghayda, Andreas Kronbichler, and Jae I. Shin 2020. "Efficacy of Corticosteroids in Patients with SARS, MERS and COVID-19: A Systematic Review and Meta-Analysis" Journal of Clinical Medicine 9, no. 8: 2392. https://doi.org/10.3390/jcm9082392

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