Covid-19 living Data

Pharmacologic treatments for covid-19 patients

Corticosteroids vs Standard Care/Placebo

This comparison will not be updated. Last search date 14 Dec, 2022

We requested data from three randomized trials evaluating corticosteroids that are yet to be published but were considered in the meta analysis" Association Between Administration of Systemic Corticosteroids and Mortality Among Critically Ill Patients With COVID-19 A Meta-analysis. We have extracted available data from this systematic review for the three unpublished studies. These have been included in our tables and forest plots.

Hospitalized patients

Forest plots
(last update: 2022-12-06)

Funnel plots
(last update: 2021-07-22)

Summary of findings
(last update: 2022-12-06)

Patient or population: COVID-19 patients
Setting: Worldwide
Intervention: Corticosteroids
Comparison: Standard Care/Placebo

Outcome	Relative effect (95% CI)	Absolute effect (95% CI)¹		Certainty of the Evidence (GRADE)
Clinical improvement D28	RR: 1.05 (1.02 - 1.08)	31 more per 1000 (from 13 more to 50 more)		High certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns regarding adequate randomisation, deviation from intended intervention, outcome measurement and selection of reported results not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Not serious
6 trials Salvarani C, 2022; Odeyemi YE, 2022; Horby P, 2020; Jamaati H, 2021; Tomazini BM, 2020; Les I, 2022 7191 participants		Corticosteroids 659 per 1,000 (640 - 677)	Standard Care/Placebo 627 per 1,000
Clinical improvement D60	RR: 1.03 (0.95 - 1.10)	29 more per 1000 (from 49 fewer to 97 more)		Low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
1 trials Les I, 2022 72 participants		Corticosteroids 1003 per 1,000 (925 - 1000)	Standard Care/Placebo 974 per 1,000
WHO progression score (level 7 or above) D28	RR: 0.88 (0.76 - 1.02)	52 fewer per 1000 (from 105 fewer to 9 more)		Low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk of bias regarding adequate randomization, deviation from intended intervention, and selection of the reported result Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for trivial effect/no effect
7 trials Salvarani C, 2022; Odeyemi YE, 2022; Corral-Gudino L, 2020; Dequin P-F, 2020; Jamaati H, 2021; Tomazini BM, 2020; Les I, 2022 979 participants		Corticosteroids 385 per 1,000 (332 - 446)	Standard Care/Placebo 437 per 1,000
WHO progression score (level 7 or above) D60	RR: *	Zero events in both groups		Very low certainty Reasons to downgrade Risk of bias: Not serious Inconsistency: Not serious Indirectness: Serious despite a multicentre design this is a single study from a single country, therefore results in this population might not be generalizable to other settings. Imprecision: Very serious no events in both groups
1 trials Les I, 2022 72 participants		Corticosteroids 0 per 1,000 (* - *)	Standard Care/Placebo 0 per 1,000
All-cause mortality D28	RR: 0.91 (0.84 - 0.98)	24 fewer per 1000 (from 43 fewer to 5 fewer)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns regarding adequate randomization, deviation from intended intervention and selection of reported results not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for benefit and the possibility for no effect/trivial effect
14 trials Les I, 2022; Salvarani C, 2022; Tang X, 2021; Odeyemi YE, 2022; Horby P, 2020; Prado Jeronimo CM, 2020; Jamaati H, 2021; Corral-Gudino L, 2020; Munch MW, 2021; Du, 2020; Angus DC, 2020; Dequin P-F, 2020; Villar J, 2020; Tomazini BM, 2020 8253 participants		Corticosteroids 243 per 1,000 (224 - 261)	Standard Care/Placebo 267 per 1,000
All-cause mortality D60	RR: 0.71 (0.13 - 3.89)	43 fewer per 1000 (from 129 fewer to 428 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding adequate randomization, deviations from intended interventions, and selection of reported result. Inconsistency: Serious Inconsistency downgraded by 1 level: I²=:56.9% Indirectness: Not serious Imprecision: Very serious due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
4 trials Odeyemi YE, 2022; Edalatifard M, 2020; Munch MW, 2021; Les I, 2022 211 participants		Corticosteroids 105 per 1,000 (19 - 576)	Standard Care/Placebo 148 per 1,000
Viral negative conversion D7	RR: 1.00 (0.77 - 1.31)	0 fewer per 1000 (from 98 fewer to 132 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: high risk of bias due to missing data and some concerns regarding deviation from intended intervention Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious due to wide confidence interval consistent with the possibility for benefit and the possibility for harm
2 trials Les I, 2022; Prado Jeronimo CM, 2020 278 participants		Corticosteroids 426 per 1,000 (328 - 559)	Standard Care/Placebo 426 per 1,000
Adverse events	RR: 1.09 (0.84 - 1.40)	18 more per 1000 (from 32 fewer to 81 more)		Moderate certainty Reasons to downgrade Risk of bias: Not serious Despite some concerns with adequate randomization, deviation from intended intervention, outcome measurement and selection of the reported results, not downgraded for risk of bias because the studies with these concerns contributed only a small proportion of weight to the effect estimate Inconsistency: Not serious Indirectness: Not serious Imprecision: Serious due to wide confidence interval consistent with the possibility for trivial effect/no effect and the possibility for harm
5 trials Les I, 2022; Salvarani C, 2022; Odeyemi YE, 2022; Corral-Gudino L, 2020; Tomazini BM, 2020 780 participants		Corticosteroids 221 per 1,000 (171 - 284)	Standard Care/Placebo 203 per 1,000
Serious adverse events	RR: 0.77 (0.51 - 1.17)	17 fewer per 1000 (from 36 fewer to 12 more)		Very low certainty Reasons to downgrade Risk of bias: Serious Risk of bias downgraded by 1 level: some concerns or high risk regarding adequate randomization, deviation from intended intervention, outcome measurement and selection of reported results. Inconsistency: Not serious Indirectness: Not serious Imprecision: Very serious Imprecision downgraded by 2 level: due to very wide confidence interval consistent with the possibility for benefit and the possibility for harm
9 trials Les, I, 2022; Salvarani C, 2022; Odeyemi YE, 2022; Edalatifard M, 2020; Corral-Gudino L, 2020; Angus DC, 2020; Dequin P-F, 2020; Tomazini BM, 2020; Munch MW, 2021 1278 participants		Corticosteroids 56 per 1,000 (37 - 85)	Standard Care/Placebo 73 per 1,000

¹The risk in the intervention group (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI)

CI: Confidence interval; RR: Risk ratio

GRADE Working Group grades of evidence
High certainty: We are very confident that the true effect lies close to that of the estimate of the effect
Moderate certainty: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different
Low certainty: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect
Very low certainty: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect

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Permanent URL for this comparison: https://covid-nma.com/living_data/index.php?comparison=39

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Trial	Funding	Comparisons		Design	Participants	Sample size	Overall risk of bias Highest assessment	Full description
		Treatment 1	Treatment 2
NCT04438980 ; EudraCT 2020-001827-15 CORTIVID Les I, Front Med, 2022 Full text Commentary Commentary	Public/non profit	Intravenous Methylprednisolone pulse	Placebo	RCT	Patients with confirmed COVID-19 (moderate) admitted to 2 centers in Spain.	N=72	Some concerns Details	Full description
NCT04673162 ; EudraCT 2020-004323-16 Salvarani C, Eur Respir J, 2022 Full text Commentary	No specific funding	Methylprednisolone	Placebo	RCT	Patients with confirmed COVID-19 (moderate-severe) admitted to 19 centers in Italy.	N=304	Low Details	Full description
NCT03852537 SMART Trial Odeyemi YE, Crit Care, 2022 Full text Commentary	Public/non profit	Methylprednisolone	Standard care	RCT	Patients with suspected or confirmed COVID-19 (mild to critical) admitted to a single center in the USA.	N=41	High Details	Full description
NCT04348305 COVID STEROID Munch MW, Acta Anaesthesiol Sc, 2021 Full text Commentary	Mixed	Hydrocortisone	Placebo	RCT	Patients with confirmed COVID-19 (severe/critical) admitted to 12 centers in Denmark	N=30	Low Details	Full description
IRCT20151227025726N17 Jamaati H, Eur J Pharmacol, 2021 Full text Commentary	Public/non profit	Dexamethasone	Standard care	RCT	Patients with confirmed COVID-19 (severe) admitted to a single center in Iran	N=50	Some concerns Details	Full description
NCT04273321 Tang X, Respiration, 2021 Full text Commentary	Public/non profit	Methylprednisolone	Placebo	RCT	Patients with confirmed COVID-19 (moderate/severe) admitted to 7 centers in China.	N=86	Some concerns Details	Full description
NCT04244591 Steroids-SARI Du, Unpublished, 2020	Public/non profit	Methylprednisolone	Standard care	RCT	Patients with confirmed COVID-19 (severe-critical) admitted to multiple centers in China	N=47	Some concerns Details	Full description
NCT04325061 DEXA-COVID19 Villar J, Unpublished, 2020	Public/non profit	Dexamethasone	Standard care	RCT	Patients with confirmed COVID-19 (critical) admitted 14 centers in Spain	N=19	Low Details	Full description
IRCT20200404046947N1 Edalatifard M, Eur Respir J, 2020 Full text Commentary	Public/non profit	Intravenous Methylprednisolone pulse	Standard care	RCT	Patients with confirmed COVID-19 (severe) admitted to two centers in Iran	N=68	Some concerns Details	Full description
IRCT20200406046963N1 Farahani R, Research Square, 2020 Full text Commentary	Public/non profit	Intravenous Methylprednisolone pulse+Prednisolone	Standard care	RCT	Patients with COVID-19 (severe) admitted to a single center in Iran	N=29	N/A	Full description
NCT04327401 Tomazini BM, JAMA, 2020 Full text Commentary	Mixed	Dexamethasone	Standard care	RCT	Patients with suspected or confirmed COVID-19 (critical) admitted to 41 centers in Brazil	N=299	Some concerns Details	Full description
NCT02735707 REMAP-CAP Angus DC, JAMA, 2020 Full text Commentary	Public/non profit	Fixed-dose hydrocortisone	Standard care	RCT	Patients with COVID-19 (severe-critical) admitted to 121 centers in 8 countries	N=251	Some concerns Details	Full description
NCT02517489 Dequin P-F, JAMA, 2020 Full text Commentary	Public/non profit	Hydrocortisone	Placebo	RCT	Patients with COVID-19 (severe-critical) admitted to 9 centers in France	N=149	Some concerns Details	Full description
EudraCT202000193437 GLUCOCOVID Corral-Gudino L, medRxiv, 2020 Full text Commentary	No specific funding	Methylprednisolone	Standard care	RCT	Patients with COVID-19 (severe) admitted to 5 centers in Spain	N=64	High Details	Full description
NCT04343729 Prado Jeronimo CM, Clin Infect Dis, 2020 Full text Commentary	Public/non profit	Methylprednisolone	Placebo	RCT	Patients with COVID-19 (moderate-critical) admitted to a single center in Brazil	N=416	High Details	Full description
NCT04381936 RECOVERY (Dex) Horby P, N Engl J Med, 2021 Full text Commentary	Mixed	Dexamethasone	Standard care	RCT	Patients with suspected and confirmed COVID-19 (mild-moderate-critical) admitted to 176 centers in the UK	N=6425	Some concerns Details	Full description