IMPORTANCE Effective therapies for patients with coronavirus disease 2019 (COVID-19) are
needed, and clinical trial data have demonstrated that low-dose dexamethasone reduced
mortality in hospitalized patients with COVID-19 who required respiratory support.
OBJECTIVE To estimate the association between administration of corticosteroids compared
with usual care or placebo and 28-day all-cause mortality.
DESIGN, SETTING, AND PARTICIPANTS Prospectivemeta-analysis that pooled data from 7
randomized clinical trials that evaluated the efficacy of corticosteroids in 1703 critically ill
patients with COVID-19. The trials were conducted in 12 countries from February 26, 2020, to
June 9, 2020, and the date of final follow-up was July 6, 2020. Pooled data were aggregated
from the individual trials, overall, and in predefined subgroups. Risk of bias was assessed
using the Cochrane Risk of Bias Assessment Tool. Inconsistency among trial results was
assessed using the I2 statistic. The primary analysis was an inverse variance–weighted
fixed-effectmeta-analysis of overall mortality, with the association between the intervention
and mortality quantified using odds ratios (ORs). Random-effects meta-analyses also were
conducted (with the Paule-Mandel estimate of heterogeneity and the Hartung-Knapp
adjustment) and an inverse variance–weighted fixed-effect analysis using risk ratios.