CHEST Guidelines-Caution-When-Comparing-the-Impact-of-Corticosteroi

Caution-When-Comparing-the-Impact-of-Corticosteroi

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The correspondence discusses the effectiveness of corticosteroids in treating severe COVID-19, highlighting various meta-analyses and the potential pitfalls of combining different study types. The initial letter to the editor emphasizes the value of combining data from multiple studies to derive an overall effect estimate but warns against mixing randomized controlled trials (RCTs) with observational studies due to inherent biases and methodological differences. The letter critiques a review by Cano et al., which included one RCT and numerous observational studies, for its inability to provide concrete recommendations on corticosteroid use in COVID-19 due to these methodological issues. The authors emphasize the need for further studies to explore various aspects of corticosteroid treatment, such as type, dosing, and timing.<br /><br />In response, Cano et al. acknowledge the concerns but defend their study's methodology, emphasizing that high-quality observational data was invaluable early in the pandemic when RCTs were still underway. They argue that meta-analyses frequently combine different study types when RCTs are scarce and highlight parallels between their findings and those of subsequent RCTs, which validate the mortality benefits of corticosteroids in critically ill COVID-19 patients. Cano et al. agree that ongoing caution is necessary as literature in this area rapidly expands, allowing for revisions and the addressing of unanswered questions.<br /><br />Both letters underscore the necessity for continued research to refine corticosteroid treatment protocols to optimize outcomes for COVID-19 patients. The MEDEAS trial and other investigations are expected to provide further insights into the most effective use of corticosteroids in this context.

Keywords

corticosteroids

COVID-19

meta-analyses

randomized controlled trials

observational studies

treatment protocols