Dexamethasone for treating SARS-CoV-2 infection: a systematic review and meta-analysis

ABSTRACT BACKGROUND: Considering the disruptions imposed by lockdowns and social distancing recommendations, coupled with overwhelmed healthcare systems, researchers worldwide have been exploring drug repositioning strategies for treating severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). OBJECTIVE: To compile results from randomized clinical trials on the effect of dexamethasone, compared with standard treatment for management of SARS-CoV-2. DESIGN AND SETTING: We conducted a systematic review and meta-analysis in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines in a Brazilian public university. METHODS: We sought to compile data from 6724 hospitalized patients with confirmed or suspected SARS-CoV-2 infection. RESULTS: Treatment with dexamethasone significantly reduced mortality within 28 days (risk ratio, RR: 0.89; 95% confidence interval, CI: 0.82-0.97). Dexamethasone use was linked with being discharged alive within 28 days (odds ratio, OR: 1.20; 95% CI: 1.07-1.33). CONCLUSIONS: This study suggests that dexamethasone may significantly improve the outcome among hospitalized patients with SARS-CoV-2 infection and associated severe respiratory complications. Further studies need to consider both dose-dependent administration and outcomes in early and later stages of the disease. PROSPERO platform: CRD42021229825.

摘要
背景：鉴于封控措施与社交距离指引所带来的多重干扰，加之医疗系统不堪重负，全球研究者一直在探索药物重定位（drug repositioning）策略，以治疗严重急性呼吸综合征冠状病毒2型（SARS-CoV-2）感染患者。
研究目的：汇总地塞米松相较于标准治疗方案，用于SARS-CoV-2感染治疗的随机临床试验（randomized clinical trial, RCT）结果。
研究设计与研究场景：本研究遵循系统评价与Meta分析首选报告条目（Preferred Reporting Items for Systematic Reviews and Meta-Analyses, PRISMA）指南，在巴西某公立大学开展系统评价与Meta分析。
研究方法：本研究共纳入6724名确诊或疑似SARS-CoV-2感染的住院患者，对其相关数据进行汇总分析。
研究结果：地塞米松治疗可显著降低患者28天死亡率（风险比（risk ratio, RR）=0.89；95%置信区间（confidence interval, CI）=0.82~0.97）。地塞米松的使用与患者28天内存活出院率升高显著相关（比值比（odds ratio, OR）=1.20；95%置信区间（confidence interval, CI）=1.07~1.33）。
研究结论：本研究表明，地塞米松可显著改善SARS-CoV-2感染合并重症呼吸道并发症住院患者的临床结局。后续研究需兼顾给药剂量依赖性，以及疾病早、晚期阶段的治疗结局差异。
PROSPERO平台：CRD42021229825。