Corticosteroid therapy for COVID-19 A systematic review and meta-analysis of randomized controlled trials

Yashwitha Sai Pulakurthi, John M. Pederson, Kavitha Saravu, Nitin Gupta, Prasanth Balasubramanian, Shelby Kamrowski, Megan Schmidt, Charan Thej Reddy Vegivinti, Mahmoud Dibas, Natalie L. Reierson, Sailaja Pisipati, Betsy Ann Joseph, Pragadeesh Thamarai Selvan, Adam A. Dmytriw, Praneeth Reddy Keesari, Varsha Sriram, Spandana Chittajallu, Waleed Brinjikji, Rewanth R. Katamreddy, Richa ChibbarAmber R. Davis, Manashree Malpe, Hemant K. Mishra, Kevin M. Kallmes, Ameer E. Hassan, Kirk W. Evanson

Research output: Contribution to journalReview articlepeer-review


Background: Corticosteroid treatment is an effective and common therapeutic strategy for various inflammatory lung pathologies and may be an effective treatment for coronavirus disease 2019 (COVID-19). The purpose of this systematic review and metaanalysis of current literature was to investigate the clinical outcomes associated with corticosteroid treatment of COVID-19. Methods: We systematically searched PubMed, medRxiv, Web of Science, and Scopus databases through March 10, 2021 to identify randomized controlled trials (RCTs) that evaluated the effects of corticosteroid therapies for COVID-19 treatment. Outcomes of interest were mortality, need for mechanical ventilation, serious adverse events (SAEs), and superinfection. Results: A total of 7737 patients from 8 RCTs were included in the quantitative meta-analysis, of which 2795 (36.1%) patients received corticosteroids plus standard of care (SOC) while 4942 (63.9%) patients received placebo and/or SOC alone. The odds of mortality were significantly lower in patients that received corticosteroids as compared to SOC (odds ratio [OR]=0.85 [95% CI: 0.76; 0.95], P=.003). Corticosteroid treatment reduced the odds of a need for mechanical ventilation as compared to SOC (OR=0.76 [95% CI: 0.59; 0.97], P=.030). There was no significant difference between the corticosteroid and SOC groups with regards to SAEs and superinfections. Conclusion: Corticosteroid treatment can reduce the odds for mortality and the need for mechanical ventilation in severe COVID-19 patients. Abbreviations: ARDS = acute respiratory distress syndrome, COVID-19 = coronavirus disease 2019, ICU = intensive care unit, OR = odds ratio, RCT = randomized controlled trial, SAE = serious adverse event, SARS-CoV = severe acute respiratory syndrome coronavirus, SOC = standard of care.

Original languageEnglish (US)
Article number20
JournalMedicine (United States)
Issue number20
StatePublished - Apr 2 2021


  • Adrenal cortex hormones
  • Coronavirus
  • Respiratory distress syndrome
  • Severe acute respiratory syndrome coronavirus-2

ASJC Scopus subject areas

  • General Medicine


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