CHEST Guidelines-Response

Response_chest

Pdf Summary

The correspondence by Edison Cano and colleagues is a response to prior feedback regarding their systematic review and meta-analysis on the impact of corticosteroids in COVID-19 outcomes. They acknowledge interest and concerns expressed by Confalonieri et al. about combining retrospective and prospective studies in meta-analyses. Despite observational studies being prone to confounders, the authors argue that during the COVID-19 pandemic, observational data were crucial due to the lag in high-quality randomized controlled trials (RCTs) being available. They highlight that while Cochrane guidelines suggest caution in mixing study types, during the pandemic, retrospective data was vital for providing timely insights into the treatment.<br /><br />Cano and colleagues note that combining observational studies with controlled trials is a common practice in contemporary literature when high-quality RCT data is not yet available. They emphasize that both types of studies can yield similar effect size estimates when rigorous methodology is applied, though it remains uncertain if this applies specifically to corticosteroids in COVID-19.<br /><br />Their meta-analysis noted a statistically significant mortality benefit in critically ill COVID-19 patients treated with corticosteroids (low heterogeneity, P = .0006; I² = 26%). This finding aligns with a later published prospective meta-analysis that confirmed the efficacy of corticosteroids, supporting their role as a crucial intervention for severe cases of COVID-19. The authors also call for continuous caution in interpreting clinical data as more study results become available, highlighting that a recent PubMed search showed a substantial increase in relevant publications available for further exploration of this topic.

Keywords

COVID-19

corticosteroids

systematic review

meta-analysis

observational studies

randomized controlled trials

mortality benefit

Confalonieri

Cochrane guidelines

clinical data