Background: The precise role of corticosteroids for treatment of coronavirus disease 2019 (COVID-19) is unclear due to lack of randomized trials.
Objective: To review the therapeutic value of corticosteroids for treatment of hospitalized patients with COVID-19 with more emphasis on randomized trials.
Methods: English literature search of electronic databases supplemented by manual search up to June 29, 2020. Search terms included corticosteroids, COVID-19, dexamethasone, methylprednisolone, hydrocortisone, mortality, safety. Randomized trials were the main focus of research, but observational studies were also reviewed.
Results: Preliminary data from the only available randomized trial “The Randomized Evaluation of COVID-19 therapy” (RECOVERY) showed that dexamethasone 6 mg/day for up to 10 days reduced 28-day mortality (the primary outcome) in hospitalized patients with COVID-19 by 17%, adjusted rate ratio (RR) 0.83, 95% CI 0.74 to 0.92 (P<0.001). The highest magnitude of mortality reduction was observed among patients receiving mechanical ventilation, RR 0.65, 95% CI; 0.51 to 0.82 (P<0.001), followed by patients receiving oxygen without mechanical ventilation, RR 0.80, 95% CI, 0.70 to 0.92 (P=0.002). However, there was a non-significant trend toward increase mortality in patients not receiving respiratory support, RR 1.22, 95% CI, 0.93 to 1.61 (P=0.14).
COVID-19, Dexamethasone, Mortality, Mechanical ventilation