The World Health Organization (WHO) has published updated guidance on the management of COVID-19. The new guidance recommends systemic corticosteroids for severe and critical COVID-19. Corticosteroids are not recommended for non-severe COVID-19.
The guidance coincides with the publication of a prospective meta-analysis conducted by the WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group which revealed that the administration of systemic corticosteroids was associated with lower 28-day all-cause mortality in COVID-19 patients, compared with usual care or placebo.
The analysis, published in JAMA, pooled data from seven randomised clinical trials evaluating the efficacy of corticosteroids in 1,703 critically ill patients, of whom 678 received systemic dexamethasone, hydrocortisone or methylprednisolone, and 1,025 received usual care or placebo.
According to the results, there were 222 deaths among the 678 patients receiving corticosteroids and 425 deaths among the 1,025 patients receiving usual care or placebo. There was no suggestion of an increased risk of serious adverse events.
Some limitations of this study include lack of consistency in the definition and reporting of serious adverse events across the trials, trials were mainly conducted in high-income settings, and one trial (RECOVERY ) contributing to 57 per cent of the weight in the primary meta-analysis.