Methodology: 4/5
Usefulness: 4/5

WHO Rapid Evidence Appraisal for COVID-19 Therapies (REACT) Working Group, Sterne JAC et al. JAMA. 2020 Oct 6;324(13):1330-1341.

Question and Methods: Prospective meta-analysis of 7 RCTs investigating the utility of systemic corticosteroids, compared with usual care/placebo, in decreasing 28-day all-cause mortality of critically-ill COVID-19 patients. 
Findings: 222 deaths among 678 patients receiving steroids and 425 deaths among 1025 patients receiving usual care. Summary OR 0.66 [95% CI 0.53-0.82] favouring steroids.  
Limitations: Patient inclusion criteria was not explicit with heterogeneity in the definitions of ‘critically-ill’, ‘standard care’, and ‘adverse events’. The search criteria were also limited.   

Interpretation: In COVID-19 patients requiring supplemental oxygen or mechanical ventilation, this study demonstrates a decreased 28-day mortality associated with systemic corticosteroid administration.  

By: Dr. Wilson Lam

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  • Hans Rosenberg

    Dr. Rosenberg is an emergency physician at the Ottawa Hospital, assistant professor at the University of Ottawa, and Director of the Digital Scholarship and Knowledge Dissemination Program.