Corticosteroids for CAP, influenza and COVID-19: when, how and benefits or harm?

Ignacio Martin-Loeches; Antoni Torres

doi:10.1183/16000617.0346-2020

Tables

TABLE 1

Systematic review and meta-analysis for the use of corticosteroids in patients with community-acquired pneumonia (CAP)

Author, year [reference]	Type of patient	Patients	RCTs	Findings
Siempos, 2008 [16]	CAP with any severity (only studies for severe CAP were found)	189	4	Limited data suggest that corticosteroid treatment lowers mortality and shortens length of hospital stay for severe CAP
Salluh, 2010 [13]	Severe CAP	415	3	Do not recommend corticosteroids for severe CAP
Chen, 2011 [17]	Any type of pneumonia including nosocomial and child pneumonia	437	6	Corticosteroids are generally beneficial for pneumonia Evidence to make recommendation is lacking
Nie, 2012 [18]	CAP with any severity	1001	9	Corticosteroids are not recommended for CAP in general; however, it is possible that corticosteroids lower mortality from severe CAP and that corticosteroid treatment >6 days may be more beneficial than ≤5 days
Cheng, 2014 [15]	Severe CAP	264	4	Limited evidence suggests that corticosteroid treatment lowers mortality from severe CAP
Shafiq, 2013 [14]	CAP requiring admission	1119	8	Corticosteroids shorten length of hospital stay Corticosteroids do not lower mortality
Horita, 2015 [19]	CAP requiring admission	1780	10	Corticosteroids shorten length of hospital stay for CAP Corticosteroids shorten length to clinical stability for CAP Corticosteroids lower mortality for CAP in ICU Corticosteroids ≥6 days is not more effective
Stern, 2017 [20]	Any type of pneumonia including nosocomial and child pneumonia	2264	17	Corticosteroids reduced mortality and morbidity in adults with severe CAP Corticosteroids reduced morbidity, but not mortality, for adults and children with nonsevere CAP Corticosteroids were associated with more adverse events, especially hyperglycaemia
Briel, 2018 [21]	CAP in Europe between 2000 and 2014	1506 (individual data analysis)	6	Corticosteroid treatment shortens time to clinical stability and length of hospital stay Corticosteroid treatment does not lower mortality Corticosteroids increased risk for CAP-related rehospitalisation and hyperglycaemia
Jiang, 2019 [22]	Severe CAP	665	10	Corticosteroids decreased all-cause mortality, incidence of septic shock and requirement for mechanical ventilation Low dose (≤86 mg·day⁻¹), prolonged use (>5 days) of corticosteroids in dosage modus of a maintenance dose after a bolus can be recommended as preferred regimen

Data are presented as n. RCT: randomised controlled trial; ICU: intensive care unit.

TABLE 2

Corticosteroids in community-acquired pneumonia (CAP) versus coronavirus disease-2019 (COVID-19)

	CAP	COVID-19
Severity	IDSA/ATS severe CAP [11]	Severe acute respiratory failure^#
Timing	First 24 h	First 24 h
Type of steroids and dosage	Prednisone (50 mg daily) Methylprednisolone (40–80 mg daily) Dexamethasone (5 mg daily)	Dexamethasone (6 mg daily) Hydrocortisone (200 mg daily)
Duration	5–8 days	7 days
Outcome	Decrease treatment failure and mortality	Decrease mortality
Harms	Increased readmission in one study	CAPA?

IDSA: Infectious Diseases Society of America; ATS: American Thoracic Society; CAPA: COVID-19-associated pulmonary aspergillosis. ^#: as defined in the RECOVERY trial [58].