• Mahmoud Yousefifard, Kosar Mohamed Ali, Abbas Aghaei, Alireza Zali, Arian Madani Neishaboori, Afshin Zarghi, Saeed Safari, Behrooz Hashemi, Mohammad Mehdi Forouzanfar, and Mostafa Hosseini.
• Physiology Research Center, Iran University of Medical Sciences, Tehran, Iran.
• Iran J Public Health. 2020 Aug 1; 49 (8): 1411-1421.

BackgroundWe aimed to examine the available evidence regarding the efficacy and safety of corticosteroids on the management of coronavirus disease 2019 (COVID-19), severe acute respiratory syndrome (SARS-CoV) and Middle East respiratory syndrome (MERS-CoV).MethodAn extensive search was conducted in Medline, Embase, and Central databases until the end of March 2020, using keywords related to corticosteroids, COVID-19, SARS-CoV and MERS-CoV. The main outcome was considered to be the mortality rate, length of stay, virus clearance time, symptom improvement, and lung function improvement. The findings are presented as odds ratio (OR) with 95% confidence interval (95% CI).ResultsFifteen paper compromising 5 studies on COVID-19, 8 studies on SARS-CoV and 2 studies on MERS-CoV were included. One study was clinical trial and the rest were cohort. The analyses showed that corticosteroids were not reduce the mortality rate of COVID-19 (OR=1.08; 95% CI: 0.34 to 3.50) and SARS-CoV (OR=0.77; 95% CI: 0.34 to 1.3) patients, while they were associated with higher mortality rate of patients with MERS-CoV (OR = 2.52; 95% CI: 1.41 to 4.50). Moreover, it appears that corticosteroids administration would not be effective in shortening viral clearance time, length of hospitalization, and duration of relief symptoms following viral severe acute respiratory infections.ConclusionThere is no evidences that corticosteroids are safe and effective on the treatment of severe acute respiratory infection when COVID-19 disease is suspected. Therefore, corticosteroids prescription in COVID-19 patients should be avoided.Copyright© Iranian Public Health Association & Tehran University of Medical Sciences.

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