To the editor

We read with interest the recently published systematic review and meta-analysis authored by Pei et al,1 which provides top level evidence regarding the impact of drug therapy on odds for death in patients infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Notably, Pei et al1 demonstrated that the use of glucocorticoids is associated with an increase in the odds for death in the context of the disease, bringing into question the use of this drug class in SARS-CoV-2 infection.

In another recent systematic review and meta-analysis, it was shown that corticosteroid use in patients infected with coronaviruses (severe acute respiratory syndrome coronavirus [SARS], Middle East respiratory syndrome coronavirus [MERS], or SARS-CoV-2) did not increase the odds for death, while, in a time-adjusted analysis according to risk factors such as age or comorbidities, corticosteroids were associated with a decrease in the risk of death.2

Of note, in the randomized, open-label RECOVERY study enrolling hospitalized patients with SARS-CoV-2 infection, dexamethasone was shown to decrease the rate of death by 36% in patients receiving mechanical ventilation and by 18% in those receiving oxygen supplementation without mechanical ventilation, compared with placebo.3 In a real world study conducted in France enrolling hospitalized patients with SARS-CoV-2 infection, it was demonstrated that initiation of corticosteroids in the treatment protocol of SARS-CoV-2 pneumonia was associated with a 53% decrease in the risk of death and a 63% decrease in the risk of intensive care unit admission or death before intensive care unit admission.4

Thus, despite the fact that in other cases of viral pneumonia such as influenza pneumonia corticosteroid use is not recommended and might increase mortality indeed,5 it seems that we have a long journey to go in the COVID-19 pandemic era. More data are required in order to elucidate the role of corticosteroid treatment in the context of SARS-CoV-2 infection.