Effectiveness and safety of glucocorticoids to treat COVID-19: a rapid review and meta-analysis

  1. on behalf of COVID-19 Evidence and Recommendations Working Group
  2. Shuya Lu
  3. Qi Zhou
  4. Liping Huang
  5. Qianling Shi
  6. Siya Zhao
  7. Zijun Wang
  8. Weiguo Li
  9. Yuyi Tang
  10. Yanfang Ma
  11. Xufei Luo
  12. Toshio Fukuoka
  13. Hyeong Sik Ahn
  14. Myeong Soo Lee
  15. Zhengxiu Luo
  16. Enmei Liu
  17. Yaolong Chen
  18. Chenyan Zhou
  19. Donghong Peng

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Abstract

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  1. ScreenIT

    SciScore for 10.1101/2020.04.17.20064469: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    Institutional Review Board Statementnot detected.
    RandomizationWe included randomized controlled trials (RCTs) and cohort studies comparing glucocorticoid therapy versus placebo or comparing a combination of glucocorticoids and symptomatic treatment with symptomatic treatment alone.
    BlindingWe assessed the risk of bias in RCTs using the Cochrane risk-of-bias tool (17), which consists of seven domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting, and other bias.
    Power Analysisnot detected.
    Sex as a biological variablenot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Search strategy: Two experienced librarians searched the following databases from January 1st, 2003 to March 31th, 2020: The Cochrane library, MEDLINE (via PubMed), Embase, Web of Science, CBM (China Biology Medicine)
    Cochrane library
    suggested: (Cochrane Library, RRID:SCR_013000)
    MEDLINE
    suggested: (MEDLINE, RRID:SCR_002185)
    PubMed
    suggested: (PubMed, RRID:SCR_004846)
    Embase
    suggested: (EMBASE, RRID:SCR_001650)
    ) Register), Google Scholar (https://scholar.google.nl/) and preprint platforms BioRxiv (https://www.biorxiv.org/), MedRxiv (https://www.medrxiv.org/) and SSRN (https://www.ssrn.com/index.cfm/en/).
    BioRxiv
    suggested: (bioRxiv, RRID:SCR_003933)
    In addition, we searched the reference lists of the identified systematic reviews to find further potential studies, and supplemented screening Google Scholar by conducting a manual search every day before submission.
    Google Scholar
    suggested: (Google Scholar, RRID:SCR_008878)
    Study selection: After eliminating duplicates, two researchers (S Lu and L Huang) independently screened the literature in two steps using the EndNote software.
    EndNote
    suggested: (EndNote, RRID:SCR_014001)
    We assessed the risk of bias in RCTs using the Cochrane risk-of-bias tool (17), which consists of seven domains: random sequence generation, allocation concealment, blinding of participants and personnel, blinding of outcome assessment, incomplete outcome data, selective outcome reporting, and other bias.
    Cochrane risk-of-bias tool
    suggested: None
    Missing data were dealt with according to the Cochrane Handbook for Systematic Reviews of Interventions (27).
    Cochrane Handbook
    suggested: None

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    Strengths and Limitations: This is to our knowledge the first comprehensive and systematic review of the effectiveness and safety of glucocorticoid therapy for patients with COVID-19 using data from the COVID-19 studies, and can be considered at the moment as the best evidence for decision-making on this topic. We conducted meta-analyses to quantitatively synthesize the findings of the included studies and objectively evaluate the current research evidence. Our study had also several limitations. We found only limited direct evidence of systemic glucocorticoids therapy for COVID-19, and had to use indirect evidence from the SARS and MERS epidemics. We also could not conduct subgroup analyses according to the dose and type of glucocorticoids because of the small number of studies.

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    About SciScore

    SciScore is an automated tool that is designed to assist expert reviewers by finding and presenting formulaic information scattered throughout a paper in a standard, easy to digest format. SciScore checks for the presence and correctness of RRIDs (research resource identifiers), and for rigor criteria such as sex and investigator blinding. For details on the theoretical underpinning of rigor criteria and the tools shown here, including references cited, please follow this link.

  2. Version published to 10.21037/atm-20-3307
  3. Version published to 10.1101/2020.04.17.20064469v1 on medRxiv