Effectiveness of Corticosteroid Therapy in COVID-19 Induced Olfactory
Dysfunction: a systematic review and meta-analysis of Randomized
Controlled Trials.
Abstract
Introduction: Covid-19 has been strongly associated with the loss of
smell also known as anosmia. It is one of the first symptoms experienced
by patients who encounter covid-19. The condition has been reported to
have a detrimental impact on psychological and emotional well-being,
physical health, and relationships thus compromising the quality of
life. Various reasons have been proposed to justify the cause of
anosmia, with apoptosis of olfactory cells and inflammation of the
mucosa amongst a few. The following study aims to shed light on the
efficacy of intranasal corticosteroids in the treatment of these
conditions. Methods: From their inception to 20 May 2023, a complete
search of electronic databases including PubMed, MEDLINE, Scopus, and
Cochrane was conducted to look for studies consisting of data regarding
short-term or long-term anosmia in COVID-19 patient populations who were
treated using intra-nasal corticosteroids.After a rigorous process of
study selection, 7 studies were shortlisted and utilized to conduct a
meta-analysis. Results: The improvement in the olfactory score at 2 and
4 weeks was statistically higher in the treatment group (Standard Mean
Difference [SMD]= 1.01 [0.07, 1.94], p-value= 0.03) as compared
to the control group (SMD = 1.25 [0.78, 1.73], P = 0.00004).
However, the results in the 4 weeks group were not significant.
Similarly, the effect of corticosteroids in patients in whom anosmia
lasted for more than 4 weeks also turned out to be insignificant (SMD =
0.51 [-0.12, 1.14], a p-value of 0.11, I2 =78%). According to the
subgroup analysis, there were no significant differences in the efficacy
of corticosteroids in short and long-term anosmia (RR = 1.26 [0.83,
1.92] and 1.57 [0.04, 70.02], p-value = 0.13). Conclusion: As per
the findings of the meta-analysis, corticosteroids do play a role in the
improvement of the olfactory dysfunction caused by COVID-19. However,
there was no difference in their efficacy for the treatment of
short-term versus long-term anosmia patients.