Table 1 The characteristics of the included studies
Author, year | Study design / country | Study interval | Sample size (F / M) | Mean age | Inclusion criteria | Intervention | Primary outcome | Quality assessment a | ||
|---|---|---|---|---|---|---|---|---|---|---|
MG | DG | MG | DG | |||||||
Fatima, 2020 [18] | Multicenter, non-RCT / Pakistan | 1 June 2020 to 30 June 2020 | 65 (NA) | 35 (NA) | 54.86 | 57.91 | 1. Age 18–75 years 2. COVID-19 PCR positive 3. O2 saturation < 94% on room air, regardless of chest X-ray findings 4. Moderate or severe COVID-19 disease according to operational definition 5.Informed consent obtained | MG: 1 mg/kg/day in 2 divided doses for 5 days DG: 8 mg/day for 5 days | NA | 17 |
Rana, 2020 [19] | Single-center, non-RCT / Pakistan | NA | 30 (9 / 21) | 30 (10 / 20) | 53.9 | 53.8 | 1. COVID-19 patients 2. Ventilated in ICU / high-dependency unit | MG: 40 mg twice daily for 8 days DG: 8 mg twice daily for 8 days | PaO2/FiO2 ratio | 13 |
Aslam, 2021 [20] | Single-center, non-RCT / Pakistan | May 2021 to June 2021 | 41 (NA) | 41 (NA) | NA | 1. Severe COVID-19 pneumonia 2. Admitted in high-dependency unit | MG: 1–2 mg/kg/day DG: 6–8 mg/day | Decrease or increase in oxygen demand | 16 | |
Buso, 2021 [21] | Single-center, non-RCT / Italy | 1 December 2020 to 31 January 2021 | 136 (44 / 92) | 110 (36 / 74) | 74.4 | 72.1 | 1. Adult patients 2. COVID-19 PCR positive 3. Presence of pneumonia detected using imaging 4. Supplementary oxygen | MG: 60 mg/day for ⩾10 days, then tapered gradually DG: 6 mg/day for ⩾10 days, then tapered gradually | 30-day all-cause mortality and the need for semi-ICU or ICU admission | 17 |
Du Plessis, 2021 [22] | Single-center, non-RCT / South Africa | 26 March 2020 to 18 July 2020 | 46 (14 / 32) | 108 (52 / 56) | 52 | 54.5 | 1. Severe COVID-19 pneumonia 2. Admitted to a COVID-dedicated ICU for respiratory support | MG: 80 mg/day for 10–14 days DG: 8 mg/day for 10–14 days | NA | 15 |
El mezzeoui, 2021 [23] | Single-center, non-RCT / Morocco | 1 March 2020 to 30 December 2020 | 230 (68 / 162) | 283 (100 / 183) | 64 | 63 | 1. Over 18 years of age 2. COVID-19 PCR positive or Chest CT typical 3. ICU stay ⩾ 7 days | MG: 1 mg/kg/day for 7 days DG: 6 mg/day for 7 days | Improvement in clinical and biological parameters | 15 |
Ko, 2021 [24] | Single-center, non-RCT / USA | 1 March 2020 to 31 July 2020 | 104 (25 / 79) | 83 (21 / 62) | 56.2 | 57.8 | 1. COVID-19 PCR positive 2. Admitted to ICU for respiratory failure from COVID-19 3. Oxygen requirement of ⩾40 L/min and FiO2 of ⩾50% | MG: 1 mg/kg/day for ⩾3 days DG: 6 mg/day for ⩾7 days | 50-day all-cause mortality | 17 |
Mora-Luján, 2021 [25] | Single-center, non-RCT / Spain | March 2020 to April 2021 | 189 (49 / 140) | 199 (56 / 143) | 67 | 67.8 | 1. COVID-19 PCR positive 2. Supplementary oxygen 3. Presenting with elevated inflammatory parameters | MG: ⩾100 mg/day for 3 days DG: 6 mg/day for 10 days | In-hospital mortality | 18 |
Pinzón, 2021 [26] | Single-center, non-RCT / Colombia | 11 June 2020 to 31 October 2020 | 105 (38 / 67) | 111 (51 / 60) | 64 | 63 | 1. Over 18 years of age 2. COVID-19 PCR positive 3. Radiological confirmation of pneumonia by chest CT 4. Supplementary oxygen | MG: 250–500 mg/day for 3 days, followed by prednisone 50 mg/day orally for 14 days DG: 6 mg/day for 7–10 days | Recovery time | 13 |
Ranjbar, 2021 [27] | Single-center, RCT / Iran | August 2020 to November 2020 | 44 (17 / 27) | 42 (20 / 22) | 56.2 | 61.3 | 1. Over 18 years of age 2. COVID-19 PCR positive 3. O2 saturation < 92% on room air | MG: 2 mg/kg/day, and tapered to half dosage every 5 days DG: 6 mg/day for 10 days | 28-day all-cause mortality and clinical status after 5 as well as 10 days after enrollment with 9-point WHO ordinal scale | Low risk |
Saeed, 2022 [28] | Single-center,RCT / Egypt | June 2020 to October 2021 | 222 (NA) | 192 (NA) | NA | 1. Over 18 years of age 2. COVID-19 PCR positive 3. Ventilated patients with ARDS | MG: 2 mg/kg/day for 5 days, then tapered to half dosage for another 5 days DG: 6 mg/day for 10 days | Clinical, laboratory, and radiological status after 10 days of enrollment | Low risk | |
Soliman, 2022 [29] | Single-center,RCT / Egypt | NA | 30 (13 / 17) | 30 (16 / 14) | 60.6 | 58.13 | 1. Over 18 years of age 2. COVID-19 patients with destructive inflammatory immune response 3. Needing ICU admission | MG: 1 mg/kg/day for 7 days DG: 8 mg/day for 7 days | Inflammatory response monitoring by neutrophil / lymphocyte ratio | Low risk |