Original Research Paper

Outcomes Of Covid-19 Amongst Patients With Ongoing Use Of Inhaled Corticosteroids - A Systematic Review & Meta-analysis

Abstract :

BackgroundThe numbers quoted by WHO for the Coronavirus disease 2019 (COVID-19) pandemic as of August 2021 were 200 million cases with over 4 million deaths globally. COVID-19 is associated with several respiratory pathologies. Inhaled corticosteroids (ICS) are used to improve lung function by reducing inflammation, edema, mucus secretion, and inhibiting various cytokine activities. However, there is limited data on the effect of ICS usage in patients with COVID-19. In this study, we aim to evaluate the association between the effectiveness of ICS and the outcomes in COVID-19 patients compared to standard COVID-19 treatment. MethodsWe followed PRISMA guidelines and MOOSE protocol for conducting the systematic review and meta-analysis comparing ICS and standard COVID-19 therapy. A search on PubMed is conducted yielding 270 articles of which 6 manuscripts are finalized for inclusion in the study. Patients with COVID-19 are identified from the studies based on confirmed positive RT-PCR tests. Hospitalization, ICU admission, and mortality are selected as the outcomes of our study. Using RevMan 5.3, we performed random-effects models to estimate the pooled effect size (pooled odds ratio), 95% confidence interval (95% CI), and heterogeneity (I2). Forest plots are obtained and p <0.05 is considered statistically significant.ResultsOf the six studies, five reported mortality. We noted a higher prevalence of mortality in patients with asthma (60.88%, 107/160) and chronic obstructive pulmonary disease (COPD) (68.46%, 382/558). The overall mortality is 7.49% (107/1428). We found that ICS use was associated with higher odds of mortality (OR=1.45 95%CI: 1.10-1.91; p=0.009, I2= 68%) amongst COVID-19 patients. In subgroup analysis, higher odds of mortality among COPD patients using ICS was noted [pooled OR: 1.52 (1.24-1.86); p<0.0001; I2=0%]. However, no significant association between ICS and mortality was observed among asthma patients. ConclusionICS is associated with increased mortality and risk for hospitalization in patients with COVID-19 as compared to standard non-steroid-based COVID-19 therapy. Future studies are needed to support the evidence of ICS discontinuation in COVID-19 patients.

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