The effect of inhaled corticosteroids on the outcomes of patients with COVID-19: A systematic review and meta-analysis of randomized controlled trials

ABSTRACT

Background

The effect of inhaled corticosteroids (ICS) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) was not known.

Research design and methods

Only phase 2 and 3 randomized clinical trials (RCTs) from electronic databases that investigated ICS in the treatment of COVID-19 patients were included. The outcomes of interest were the resolution of symptoms, risk of hospitalization or urgent medical visit, mortality, and the incidence of adverse events (AEs).

Results

Five RCTs involving 1243 patients who received ICS and 1526 patients with placebo or usual care were included. The ICS group had a higher rate of symptom resolution than the control group at day 14 (risk ratio [RR], 1.21; 95% confidence interval [CI], 1.12-1.30, p < 0.00001) and day 28 (RR, 1.12; 95% CI, 1.06-1.18, p < 0.0001). Additionally, the ICS group had a significantly lower risk of needing urgent medical care or hospitalization than the control group (RR, 0.15; 95% CI, 0.05-0.50; I2 = 0, p = 0.002). However, no significant difference in the 28-day mortality rate.     

Conclusions

In patients with mild-to-moderate COVID-19, ICS therapy improved symptom resolution, and decreased the risk of needing urgent medical care or hospitalization.

KEYWORDS:

• COVID-19
• inhaled corticosteroids
• SARS-CoV-2

Article Highlights

• The effect of inhaled corticosteroids (ICS) on the clinical outcomes of patients with coronavirus disease 2019 (COVID-19) was not known.

• This systematic review and meta-analysis included five clinical trials with 1243 patients; we found that early administration of inhaled corticosteroids therapy improved symptom resolution, decreased the risk of needing urgent medical care or hospitalization, and did not increase adverse events in non-hospitalized patients and in those with mild-to-moderate COVID-19.

• These findings suggest that early treatment with inhaled corticosteroids could improve clinical outcomes in mild-to-moderate or non-hospitalized COVID-19 patients.

Ethics approval and consent to participate

This article does not include any studies with human participants or animals performed by any of the authors.

Data availability

The datasets used and analyzed in the current study are available from the corresponding author on reasonable request.

Competing interests

None of the authors have any conflicts of interest to disclose.

Supplementary material

Supplemental data for this article can be accessed here

Additional information

Funding

This study was supported by Taichung Veterans General Hospital (TCVGH-1114401C).