Steroids in acute respiratory distress syndrome: A panacea or still a puzzle?

Table 3 Comparison of studies of steroids in coronavirus disease 2019 requiring invasive mechanical ventilation

Ref.	Acronym/Abbreviation	Country, number of participating sites	Number of patients	Type of patient population	Intervention group	Control group	Primary outcome	Comments
Angus et al[16], 2020	REMAP-CAP	Multi-national, 121	403	Adults with presumed or confirmed COVID-19 infection admitted to ICU for respiratory or cardiovascular organ support	2 dosing regimens: Fixed dose – IV Hydrocortisone 50 mg every 6 h for 7 d; Shock-dependant dose - IV Hydrocortisone 50 mg every 6 h while in shock for up to 28 d	No hydrocortisone	Organ-support free days within 21 d	Pragmatic and international design improving the generalizability of results, open-label design with no blinding
Horby et al[14], 2020	RECOVERY	United Kingdom, 175	6425	Adults hospitalized with COVID-19 (later age-limit was removed with inclusion of pregnant or breast-feeding women)	IV or oral Dexamethasone 6 mg for 10 d	Usual care	All-cause mortality within 28 d	First trial showing evidence of benefit of corticosteroids in viral pneumonias
Jeronimo et al[17], 2020	Metcovid	Brazil, 1	416	Adults hospitalized with clinical or radiologically suspected COVID-19	IV Methylprednisolone (0.5 mg/kg) twice daily for 5 d	Placebo	Mortality at 28 d	Single centre study with low sample size
Dequin et al[18], 2020	CAPE COVID	France, 9	149	Adults with confirmed of suspected COVID-19 and acute respiratory failure	IV hydrocortisone 200 mg/d for 7 d followed by tapering dosage till day 14	Placebo	Treatment failure on day 21	Trial stopped early due to release of results of the RECOVERY trial, underpowered
Munch et al[19], 2021	COVID STEROID	Denmark, 12	30	Adults with COVID-19 and severe hypoxia (use of mechanical ventilation or supplementary oxygen with a flow of at least 10 L/min)	IV Hydrocortisone 200 mg/d for 7 d or until hospital discharge	Placebo	Number of days alive without life support at day 28	Trial terminated early due to external evidence indicating benefit of steroids in COVID-19
Munch et al[20], 2021	COVID STEROID 2	Multinational (Europe and India), 26	982	Adults with COVID-19 and severe hypoxaemia (use of mechanical ventilation or supplementary oxygen with a flow of at least 10 L/min)	IV Dexamethasone 12 mg once daily for up to 10 d	IV Dexamethasone 6 mg once daily for up to 10 d	Number of days alive without life support at day 28	Good generalizability of results since it was conducted in both Europe and India

ARDS: Acute respiratory distress syndrome; COVID-19: Coronavirus disease 2019; CAP: Community-acquired pneumonia; ICU: Intensive care unit.