DSEN Abstract
Systemic Corticosteroid Treatment of COVID-19 Outpatients in Canada

A study conducted by the Canadian Network for Observational Drug Effect Studies (CNODES)

Summary and Key Messages

This population-based study of COVID-19 outpatients in three Canadian provinces, demonstrated that use of systemic corticosteroid therapy as a treatment for COVID-19 was limited during the first year of the pandemic.
Further research is needed to continue to monitor corticosteroid prescribing in outpatients with mild to moderate COVID-19, and to study its safety, particularly in long-term care settings where it is most frequently prescribed.

Project Lead & Team

This research was funded by CIHR – Drug Safety and Effectiveness Network and conducted by CNODES.

For more information, please contact info@cnodes.ca.

What is the issue?

National Institutes of Health COVID-19 Treatment Guidelines recommend that systemic dexamethasone not be used in outpatients with mild to moderate COVID-19, or in hospitalized patients not requiring supplemental oxygen. However, a recent US showed that 15% of outpatients were prescribed systemic corticosteroids (CS) within 14 days of COVID-19 infection.

What was the aim of the study?

Our main objective was to describe the clinical and demographic characteristics and outcomes of Canadians infected with SARS-CoV-2 as outpatients, according to whether they initiated outpatient systemic CS therapy during the 14 days following diagnosis with COVID-19.

How was the study conducted?

This was a population-based cohort study using administrative health data from three Canadian provinces (British Columbia, BC; Manitoba, MB; and Ontario, ON [over age 65]) during the first year of the pandemic: April 1, 2020, to January 31, 2021.
The cohort included residents with a first instance of COVID-19 (positive SARS-CoV-2 nucleic acid laboratory test) in an outpatient setting.
Follow-up was 30 days from the date of the positive test or date of dispensing of a systemic CS during the 14 days following COVID-19 diagnosis. Patients were censored if they died or were hospitalized during the 14-day exposure ascertainment window.
We determined the percentage of patients newly dispensed systemic CS therapy by province, overall and by month; the demographic and clinical characteristics of patients; and the 30-day rates of hospitalization, COVID-19-related hospitalization, and death according to whether patients initiated CS therapy, overall and by long-term care (LTC) residence.

What did the study find?

We studied 108,338 eligible COVID-19 outpatients: 50,869 in BC; 23,545 in MB; and 33,924 in ON.
- Mean age: 40 years in MB and BC; 70 years in ON
- LTC residents: 5% in MB and BC; 39% in ON
Newly prescribed CS: 1.8% of MB and BC; 6% in ON
- CS recipients were older and more likely to reside in LTC, had a greater prevalence of comorbidities and concomitant medications, and were more likely to use health services than non-recipients.
- CS recipients had higher 30-day rates of hospitalization, COVID-19-related hospitalization, and death, compared with non-recipients.