Cochrane · systematic review · CD014963
Systemic corticosteroids for the treatment of COVID‐19: Equity‐related analyses and update on evidence
Wagner, C, Griesel, M, Mikolajewska, A, et al. · Cochrane Database of Systematic Reviews · 2022 · Cochrane Library
SoF tableOnly the outcomes this review put in its Summary of Findings table are listed (the Cochrane Handbook caps them at about seven per comparison). Its other analyses are not shown here.
Questions
24
current version
GRADE rated
16
No studies
8
Included studies
NR
No studies 8 · 33.3%Ungraded 0 · 0%Very low 11 · 45.8%Low 4 · 16.7%Moderate 1 · 4.2%High 0 · 0%
Ungraded means an effect was reported without a GRADE rating; it is not a gap. No studies means the review found nothing to answer the question. The six categories are a display order, not a score.
Questions and results
Current version onlySummary of findings table ‐ Corticosteroids plus standard care compared to standard care (plus/minus placebo) for hospitalised and unvaccinated individuals with a confirmed or suspected diagnosis of symptomatic COVID‐19
Population: hospitalised and unvaccinated individuals with a confirmed or suspected diagnosis of symptomatic COVID‐19
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality up to 30 days Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | RR 0.9 [0.84, 0.97] | 9 studies · 7898 participants | Moderate Downgraded: risk of bias |
All‐cause mortality up to 120 days Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | RR 0.74 [0.23, 2.34] | 3 studies · 485 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Clinical improvement: discharged alive ( Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | RR 1.07 [1.03, 1.11] | 3 studies · 6786 participants | Low Downgraded: risk of bias, inconsistency |
Clinical worsening: new need for invasive mechanical ventilation or death Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | RR 0.92 [0.84, 1.01] | 2 studies · 5586 participants | Low Downgraded: risk of bias, inconsistency |
Serious adverse events ( Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | no estimate extracted | 2 studies · 678 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events (any grade) ( Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | no estimate extracted | 3 studies · 447 participants | Very low Downgraded: risk of bias, imprecision |
Hospital‐acquired infections ( Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | no estimate extracted | 4 studies · 598 participants | Very low Downgraded: risk of bias, imprecision |
Invasive fungal infections ( Summary of findings table ‐ Corticosteroids plus standard care vs standard care (plus/minus placebo) | no estimate extracted | 1 study · 64 participants | Very low Downgraded: risk of bias, imprecision |
Summary of findings table ‐ Methylprednisolone compared to dexamethasone for hospitalised and unvaccinated individuals with a confirmed or suspected diagnosis of symptomatic COVID‐19
Population: hospitalised and unvaccinated individuals with a confirmed or suspected diagnosis of symptomatic COVID‐19
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality up to 30 days Summary of findings table ‐ Methylprednisolone vs dexamethasone | RR 0.51 [0.24, 1.07] | 1 study · 86 participants | Very low Downgraded: risk of bias, imprecision |
All‐cause mortality up to 120 days ‐ not reported Summary of findings table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Clinical improvement: discharged alive ‐ not reported Summary of findings table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Clinical worsening: new need for invasive mechanical ventilation or death ‐ not reported Summary of findings table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Serious adverse events ‐ not reported Summary of findings table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Adverse events ‐ not reported Summary of findings table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Hospital‐acquired infections ‐ not reported Summary of findings table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Invasive fungal infections ‐ not reported Summary of findings table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) compared to low‐dose dexamethasone (6 mg to 8 mg) for hospitalised individuals with unknown vaccination status and a confirmed diagnosis of symptomatic COVID‐19
Population: hospitalised individuals with unknown vaccination status and a confirmed diagnosis of symptomatic COVID‐19
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality up to 30 days Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | RR 0.87 [0.73, 1.04] | 3 studies · 1269 participants | Low Downgraded: risk of bias, imprecision |
All‐cause mortality up to 120 days Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | RR 0.93 [0.79, 1.08] | 4 studies · 1383 participants | Very low Downgraded: risk of bias, imprecision, inconsistency |
Clinical improvement: discharged alive ( Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | RR 0.98 [0.89, 1.09] | 1 study · 200 participants | Low Downgraded: risk of bias, imprecision |
Clinical worsening: new need for invasive mechanical ventilation or death ‐ not reported Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | no estimate extracted | NR | No studies |
Serious adverse events ( Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | no estimate extracted | 2 studies · 1080 participants | Very low Downgraded: risk of bias, imprecision |
Adverse events (any grade) ( Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | no estimate extracted | 1 study · 98 participants | Very low Downgraded: risk of bias, imprecision |
Hospital‐acquired infections ( Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | no estimate extracted | 2 studies · 1080 participants | Very low Downgraded: risk of bias, imprecision |
Invasive fungal infections ( Summary of findings table ‐ High‐dose dexamethasone (12 mg or higher) vs low‐dose dexamethasone (6 mg to 8 mg) | no estimate extracted | 2 studies · 1080 participants | Very low Downgraded: risk of bias, imprecision |
Summary of Findings Table ‐ Systemic corticosteroids plus standard care compared to standard care for adults with a suspected or confirmed diagnosis of COVID‐19
Population: adults with a suspected or confirmed diagnosis of COVID‐19
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of Findings Table ‐ Systemic corticosteroids plus standard care vs standard care | RR 0.89 [0.8, 1] | 9 studies · 7930 participants | Moderate Downgraded: risk of bias, imprecision, indirectness, publication bias |
Clinical improvement: ventilator‐free days Summary of Findings Table ‐ Systemic corticosteroids plus standard care vs standard care | no estimate extracted | 1 study · 299 participants | Low Downgraded: risk of bias, imprecision, indirectness, publication bias |
Clinical worsening: new need for IMV Summary of Findings Table ‐ Systemic corticosteroids plus standard care vs standard care | no estimate extracted | 4 studies · 427 participants | Very low Downgraded: risk of bias, imprecision, indirectness, publication bias |
Quality of life, including fatigue and neurological status ‐ not reported Summary of Findings Table ‐ Systemic corticosteroids plus standard care vs standard care | no estimate extracted | NR | No studies |
Serious adverse events ( Summary of Findings Table ‐ Systemic corticosteroids plus standard care vs standard care | no estimate extracted | 2 studies · 678 participants | Very low Downgraded: risk of bias, imprecision, indirectness, publication bias |
Adverse events ( Summary of Findings Table ‐ Systemic corticosteroids plus standard care vs standard care | no estimate extracted | 5 studies · 660 participants | Very low Downgraded: risk of bias, imprecision, indirectness, publication bias |
Hospital‐acquired infections ( Summary of Findings Table ‐ Systemic corticosteroids plus standard care vs standard care | no estimate extracted | 5 studies · 660 participants | Very low Downgraded: risk of bias, imprecision, indirectness, publication bias |
Summary of Findings Table ‐ Methylprednisolone compared to dexamethasone for adults with a suspected or confirmed diagnosis of COVID‐19
Population: adults with a suspected or confirmed diagnosis of COVID‐19
| Outcome | Effect | Evidence | Status / GRADE |
|---|---|---|---|
All‐cause mortality Summary of Findings Table ‐ Methylprednisolone vs dexamethasone | RR 0.51 [0.24, 1.07] | 1 study · 86 participants | Very low Downgraded: risk of bias, imprecision |
Clinical improvement: ventilator‐free days ‐ not reported Summary of Findings Table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Clinical worsening: new need for IMV Summary of Findings Table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | 1 study · 86 participants | Very low Downgraded: risk of bias, imprecision |
Quality of life, including fatigue and neurological status ‐ not reported Summary of Findings Table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Serious adverse events ‐ not reported Summary of Findings Table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Adverse events ‐ not reported Summary of Findings Table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |
Hospital‐acquired infections ‐ not reported Summary of Findings Table ‐ Methylprednisolone vs dexamethasone | no estimate extracted | NR | No studies |