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Sahu AK, Mathew R, Bhat R, et al. Steroids Use in Non-Oxygen requiring COVID-19 Patients: A Systematic Review and Meta-analysis. QJM. 2021 Aug 4. pii: 6339640. doi: 10.1093/qjmed/hcab212. (Systematic review)

BACKGROUND: Corticosteroids have become the mainstay treatment in severe COVID-19. However its role is mild disease is controversial due to lack of robust scientific evidence. This systematic review and meta-analysis was conducted to assess effect of steroids in mild COVID-19 patients.

METHODS: PubMed, EMBASE, Web of Science and Medrxiv were searched from December-31, 2019 to May-14, 2021 for studies that reported effectiveness of steroids in non-oxygen requiring COVID-19 patients in terms of progressing to severe disease, mortality, duration of fever, duration of viral clearance and length of hospital stay. Studies on inhalational steroids, case reports and reviews were excluded. Risk of bias (ROB) was assessed by the Cochrane's ROB tool and ROBANS tool. Quantitative data synthesis was done using the generic inverse variance method.

RESULTS: 6411 studies were identified, 2990 articles were screened after exclusion. Seven studies which fit the criteria (involving 2214 non-oxygen requiring COVID 19 patients) were included and analysed. Overall odds of progression to severe disease among the non-oxygen requiring COVID-19 patients receiving steroids was 5.97 (95%CI: 1.27-27.99, I 2 - 0%) and odds of death (OR: 1.35, 95%CI: 1.01-1.79; I 2-0%) as compared to the patients not receiving steroids. Mean duration of fever (7.4 days), duration to viral clearance (18.9 days), and length of hospital stay (20.8 days) were significantly higher in the steroid arm, as compared to that in no-steroid arm (6.7 days, 16.5 days, 15.2 days respectively).

CONCLUSION: Steroids in non-oxygen requiring COVID-19 patients can be more detrimental than beneficial.

PROTOCOL REGISTRATION: The study was prospectively registered in PROSPERO (CRD 42021254951).

Discipline Area Score
Hospital Doctor/Hospitalists 7 / 7
Internal Medicine 7 / 7
Emergency Medicine 6 / 7
Infectious Disease 5 / 7
Comments from MORE raters

Emergency Medicine rater

Helpful to help combat misinformation and help support current practice in the emergency and outpatient settings. The article's release is a bit behind, as we are currently in a fourth wave and this seems to have been written prior to the third wave.

Hospital Doctor/Hospitalists rater

Although specific conclusions of the paper are arguable, clearly this study presents at least the lack of benefit with steroids in less-than-severe COVID-19.

Hospital Doctor/Hospitalists rater

This review of the evidence for steroids in non oxygen requiring patients fortifies what has been evident in practice: patients prematurely given steroids have a worse clinical course and are less likely to recover quickly once progressing clinically to require oxygen. As a practicing hospitalist, I find this will also influence the decision to continue steroids in those patients who no longer require oxygen after treatment with steroids and Remdesivir. This should definitely be shared with our EM and IM and FM colleagues who see the majority of these patients before they admitted.

Infectious Disease rater

Detrimental outcome with steroid use in mild COVID 19 infection is fairly well known. This metaanalysis confirms this nicely and serves as a reference paper to substantiate the same.
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