In the Journals

Corticosteroid treatment for influenza may increase mortality risk

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December 31, 2014

Based on results from observational studies, treatment with corticosteroids for suspected influenza complications may be associated with increased mortality.

Currently available data, however, are not sufficient to draw conclusions regarding the value of corticosteroids in treating influenza complications, researchers said.

In a systematic review and meta-analysis, researchers from the United Kingdom searched for experimental and observational studies pertaining to systemic corticosteroid therapy complications presumably related to influenza. Studies assessing either intravenous or oral administrations of corticosteroids were eligible for inclusion, and no limitations were applied regarding dose or duration.

After applying various exclusion criteria, the researchers identified 16 articles for the systematic review, which included 3,039 individuals. All studies were observational. Nine of 10 studies used in a meta-analysis of mortality evaluated patients during the 2009 influenza A(H1N1) pandemic when revised WHO guidance — recommending that corticosteroids not be used to treat influenza infection — would have applied. The researchers wrote that indications for corticosteroids and the doses used were not fully specified in many of the studies, and mortality-specific data were inconsistent.

Regardless, results suggested corticosteroid therapy increased the odds of mortality (OR=2.12; 95% CI, 1.36-3.29), and a similar correlation was found in a subgroup analysis of adjusted estimates from four studies with very low statistical heterogeneity (OR=2.82; 95% CI, 1.61-4.92).

“This systematic review highlights the fact that a firm conclusion regarding the value of corticosteroid therapy for influenza cannot be drawn from the current evidence base alone,” the researchers wrote. “In the meantime, the findings from this review support the existing recommendations from the WHO that corticosteroids should not be used in the treatment of influenza infection, unless indicated for other reasons such as vasopressor-dependent septic shock, or as part of an approved research protocol.”

Disclosure: See the study for a full list of relevant financial disclosures.

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