Comparison of corticosteroids types, dexamethasone, and methylprednisolone in patients hospitalized with COVID-19: A systematic review and network meta-analysis

Mina Morsali; Amin Doosti-Irani; Shahideh Amini; Maryam Nazemipour; Mohammad Ali Mansournia; Rasoul Aliannejad

doi:10.1016/j.gloepi.2023.100116

Comparison of corticosteroids types, dexamethasone, and methylprednisolone in patients hospitalized with COVID-19: A systematic review and network meta-analysis

Glob Epidemiol. 2023 Jul 31:6:100116. doi: 10.1016/j.gloepi.2023.100116. eCollection 2023 Dec.

Authors

Mina Morsali¹, Amin Doosti-Irani¹, Shahideh Amini², Maryam Nazemipour³, Mohammad Ali Mansournia³, Rasoul Aliannejad^{4

5}

Affiliations

¹ Department of Epidemiology, School of Public Health, Hamadan University of Medical Sciences, Hamadan, Iran.
² Department of Clinical Pharmacy, Faculty of Pharmacy, Tehran University of Medical Sciences, Tehran, Iran.
³ Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran.
⁴ Division of pulmonary and critical care, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran.
⁵ Advanced Thoracic Research Center, Tehran University of Medical Sciences, Tehran, Iran.

Abstract

Background: COVID-19 is associated with severe pneumonia lung damage, acute respiratory distress syndrome (ARDS), and mortality. In this study, we aimed to compare corticosteroids' effect on the mortality risk in patients hospitalized with COVID-19.

Methods: PubMed, Web of Science, Scopus, Cochrane Library, and Embase, were searched using a predesigned search strategy. Randomized controlled trials (RCTs) that had compared the corticosteroid drugs were included. The hazard ratio (HR) with a 95% confidence interval (CI) was used to summarize the effect size from the network meta-analysis (NMA).

Results: Out of 329 retrieved references, 12 RCTs with 11,455 participants met the eligibility criteria in this review. The included RCTs formed one network with six treatments. In addition, five treatments in two RCTs were not connected to the network. Methylprednisolone + usual care (UC) versus UC decreased the risk of death by 0.65 (95% CI: 0.47, 0.90). Among treatments in the network the highest P-score (0.89) was related to Methylprednisolone + UC.

Conclusion: Based on the results of this NMA it seems Methylprednisolone + UC to be the best treatment option in patients with COVID-ARDS and COVID pneumonia.

Keywords: COVID-19; Dexamethasone; Hydrocortisone; Methylprednisolone; Network meta-analysis.

Publication types

Review