The efficacy and safety of corticosteroids in treating severe COVID-19 patients: A meta-analysis with trial sequential analysis.

BACKGROUND AND OBJECTIVE

Corticosteroids (CSs) are often administered for coronavirus disease 2019 (COVID-19); however, the advantages and disadvantages of CSs remain controversial. Accordingly, we performed a meta-analysis with trial sequential analysis (TSA) to ascertain the efficacy and safety of CSs in treating COVID-19.

METHODS

From their inception until April 2023, PubMed, Embase, The Cochrane Library, Web of Science, and China Biology Medicine(CBM) were searched to gather randomized controlled trials on the administration of CSs for COVID-19 treatment. Following the literature screening according to the inclusion criteria, data extraction and quality assessment were conducted by two reviewers, and then we conducted a meta-analysis with trial sequential analysis using RevMan 5.4 and TSA v0.9, respectively. This meta-analysis adhered to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines, and the study protocol was registered with PROSPERO (CRD42023458633).

RESULTS

A total of 6,077 literatures were obtained through the search, and 14 studies were finally included for quantitative meta-analysis. The meta-analysis revealed that the all-cause mortality in the group treated with CSs and standard treatment was significantly lower than that in the control group that received only standard treatment (RR 0.89, 95% CI: 0.82-0.96, P=0.002), with a statistically significant difference. However, the TSA analysis revealed that the cumulative Z value exceeded the traditional boundary value yet did not surpass the TSA boundary value, indicating a possibility of false positive outcomes in the meta-analysis. The incidence of adverse reactions in the group receiving CSs treatment was higher than that in the control group, but the distinction was not statistically significant (RR 1.02, 95% CI: 0.64-1.63, P=0.93).

CONCLUSION

CSs appear to be effective and safe in decreasing the overall mortality of patients who suffer from severe COVID-19; however, further assessment is required to determine adverse reactions and improvements in clinical symptoms associated with CS administration.