Implementation of Recommendations on the Use of Corticosteroids in Severe COVID-19
Authors: Camirand-Lemyre Félix , Merson Laura , Tirupakuzhi Vijayaraghavan Bharath Kumar , Burrell Aidan J. C. , Citarella Barbara Wanjiru , Domingue Marie-Pier , Lévesque Simon , Usuf Effua , Wils Evert-Jan , Ohshimo Shinichiro , Martin-Loeches Ignacio , Sǎndulescu Oana , Laake Jon Henrik , Lamontagne François ,   ISARIC Clinical Characterisation Group, Abdukahil Sheryl Ann , Abdulkadir Nurul Najmee , Abe Ryuzo , Abel Laurent , Abrous Amal , Absil Lara , Abu Jabal Kamal , Abu Salah Nashat , Acker Andrew , Adam Elisabeth , Adrião Diana , Ageel Saleh Al , Ahmed Shakeel , Ainscough Kate , Airlangga Eka , Aisa Tharwat , Ait Hssain Ali , Ait Tamlihat Younes , Akimoto Takako , Akmal Ernita , Akwani Chika , Al Qasim Eman , Alalqam Razi , Alameen Aliya Mohammed , Alberti Angela , Al-dabbous Tala , Alegesan Senthilkumar , Alessi Marta , Alex Beatrice , Alexandre Kévin , Al-Fares Abdulrahman , Alfoudri Huda , Ali Imran , Ali Adam , Alidjnou Kazali Enagnon , Alkhafajee Qabas , Allavena Clotilde , Allou Nathalie , Alves João , Alves Rita , Alves João Melo , Alves Cabrita Joana , Amaral Maria , Amira Nur , Andini Roberto , Andréjak Claire , Angheben Andrea , Angoulvant François , Ansart Séverine , Anthonidass Sivanesen , Antonelli Massimo , Antunes de Brito Carlos Alexandre , Apriyana Ardiyan , Arabi Yaseen , Aragao Irene , Arancibia Francisco , Araujo Carolline , Arcadipane Antonio , Archambault Patrick , Arenz Lukas , Arlet Jean-Benoît , Arnold-Day Christel , Arora Lovkesh , Arora Rakesh , Artaud-Macari Elise , Asensio Angel , Ashley Elizabeth A. , Ashraf Muhammad , Assie Jean Baptiste , Asyraf Amirul , Atif Minahel , Atique Anika , Attanyake AM Udara Lakshan , Auchabie Johann , Aumaitre Hugues , Auvet Adrien , Axelsen Eyvind W. , Azemar Laurène , Azoulay Cecile , Babatunde Hakeem , Bach Benjamin , Bachelet Delphine , Badr Claudine , Bævre-Jensen Roar , Baig Nadia , Baillie John Kenneth , Baird J Kevin , Bak Erica , Bakakos Agamemnon , Bakar Nazreen Abu , Bal Andriy , Balakrishnan Mohanaprasanth , Bani-Sadr Firouzé , Barbalho Renata , Barbosa Nicholas Yuri , Barclay Wendy S. , Barnett Saef Umar , Barnikel Michaela , Barrasa Helena , Barrigoto Cleide , Bartoli Marie , Baruch Joaquín , Basmaci Romain , Basri Muhammad Fadhli Hassin , Battaglini Denise , Bauer Jules , Bautista Rincon Diego Fernando , Bazan Dow Denisse , Beane Abigail , Bedossa Alexandra , Bee Ker Hong , Begum Husna , Behilill Sylvie , Beishuizen Albertus , Beljantsev Aleksandr , Bellemare David , Beltrame Anna , Beltrão Beatriz Amorim , Beluze Marine , Benech Nicolas , Benjiman Lionel Eric , Bennett Suzanne , Bento Luís , Berdal Jan-Erik , Bergeaud Delphine , Bergin Hazel , Bernal Sobrino José Luis , Bertoli Giulia , Bertolino Lorenzo , Bessis Simon , Bevilcaqua Sybille , Bezulier Karine , Bhatt Amar , Bhavsar Krishna , Bianco Claudia , Bidin Farah Nadiah , Bin Humaid Felwa , Bin Kamarudin Mohd Nazlin , Bisoffi Zeno , Biston Patrick , Bitker Laurent , Bittaye Mustapha , Bitton Jonathan , Blanco-Schweizer Pablo , Blier Catherine , Bloos Frank , Blot Mathieu , Boccia Filomena , Bodenes Laetitia , Bogaert Debby , Boivin Anne-Hélène , Bolaños Isabela , Bolze Pierre-Adrien , Bompart François , Bonfasius Aurelius , Borges Diogo , Borie Raphaël , Bosse Hans Martin , Botelho-Nevers Elisabeth , Bouadma Lila , Bouchaud Olivier , Bouchez Sabelline , Bouhmani Dounia , Bouhour Damien , Bouiller Kévin , Bouillet Laurence , Bouisse Camile , Bountthasavong Latsaniphone , Boureau Anne-Sophie , Bourke John , Bouscambert Maude , Bousquet Aurore , Bouziotis Jason , Boyer-Besseyre Marielle , Boylan Maria , Bozza Fernando Augusto , Braconnier Axelle , Braga Cynthia , Brandenburger Timo , Brás Monteiro Filipa , Brazzi Luca , Breen Patrick , Breen Dorothy , Brewster David , Brickell Kathy , Broadley Tessa , Brotherton Helen , Browne Shaunagh , Browne Alex , Brozzi Nicolas , Brunvoll Sonja Hjellegjerde , Brusse-Keizer Marjolein , Bryda Petra , Buchtele Nina , Bugaeva Polina , Buisson Marielle , Buonsenso Danilo , Burhan Erlina , Bustos Ingrid G. , Butnaru Denis , Cabie André , Cabral Susana , Cabrita Joana , Caceres Eder , Cadoz Cyril , Caetano Garcês Rui , Calligy Kate , Calvache Jose Andres , Camões João , Campana Valentine , Campbell Paul , Campisi Josie , Canepa Cecilia , Cantero Mireia , Caoili Janice , Caraux-Paz Pauline , Cárcel Sheila , Cardoso Sofia , Cardoso Filipe , Cardoso Filipa , Cardoso Nelson , Carelli Simone , Carlier Nicolas , Carmoi Thierry , Carney Gayle , Carqueja Inês , Carret Marie-Christine , Carrier François Martin , Carroll Ida , Carson Gail , Casanova Maire-Laure , Cascão Mariana , Casey Siobhan , Casimiro José , Cassandra Bailey , Castañeda Silvia , Castanheira Nidyanara , Castor-Alexandre Guylaine , Castro Ivo , Catarino Ana , Catherine François-Xavier , Cattaneo Paolo , Cavalin Roberta , Cavalli Giulio Giovanni , Cavayas Alexandros , Ceccato Adrian , Ceesay Masaneh , Cervantes-Gonzalez Minerva , Cevik Muge , Chair Anissa , Chakveatze Catherine , Chan Adrienne , Chand Meera , Chapplain Jean-Marc , Charpentier Charlotte , Chas Julie , Chávez Iñiguez Jonathan Samuel , Chen Anjellica , Chen Yih-Sharng , Chenard Léo , Cheng Matthew Pellan , Cheret Antoine , Chiarabini Thibault , Chica Julian , Chidambaram Suresh Kumar , Chin Tho Leong , Chirouze Catherine , Chiumello Davide , Cho Sung-Min , Cholley Bernard , Chommanam Danoy , Chopin Marie-Charlotte , Chow Ting Soo , Christy Nathaniel , Chua Hiu Jian , Chua Jonathan , Cidade Jose Pedro , Cisneros Herreros José Miguel , Ciullo Anna , Clarke Jennifer , Claure-Del Granado Rolando , Clohisey Sara , Codan Cassidy , Cody Caitriona , Coles Jennifer , Colin Gwenhaël , Collins Michael , Combs Pamela , Connolly Jennifer , Connor Marie , Conrad Anne , Conway Elaine , Cooke Graham S. , Cordel Hugues , Corley Amanda , Cornelis Sabine , Cornet Alexander Daniel , Corpuz Arianne Joy , Cortegiani Andrea , Corvaisier Grégory , Couffignal Camille , Couffin-Cadiergues Sandrine , Courtois Roxane , Cousse Stéphanie , Cregan Rachel , Cristella Cosimo , Crowl Gloria , Crump Jonathan , Cruz Claudina , Cruz Bermúdez Juan Luis , Cruz Rojo Jaime , Csete Marc , Cullen Ailbhe , Cummings Matthew , Curley Gerard , Curlier Elodie , Curran Colleen , Custodio Paula , da Silva Filipe Ana , Da Silveira Charlene , Dabaliz Al-Awwab , Dagens Andrew , Dahl John Arne , Dahly Darren , D'Alessandro Umberto , Daley Peter , Dalton Jo , Dalton Heidi , Daly Seamus , Damas Juliana , Daneman Nick , Dankwa Emmanuelle A , Dantas Jorge , D'Aragon Frédérick , de Jong Menno , de Loughry Gillian , de Mendoza Diego , De Montmollin Etienne , de Oliveira França Rafael Freitas , de Pinho Oliveira Ana Isabel , De Rosa Rosanna , De Rose Cristina , de Silva Thushan , de Vries Peter , Deacon Jillian , Dean David , Debard Alexa , DeBenedictis Bianca , Debray Marie-Pierre , DeCastro Nathalie , Dechert William , Decours Romain , Defous Eve , Delacroix Isabelle , Delaveuve Eric , Delavigne Karen , Delfos Nathalie M. , Deligiannis Ionna , Dell'Amore Andrea , Delmas Christelle , Delobel Pierre , Delsing Corine , Demonchy Elisa , Denis Emmanuelle , Deplanque Dominique , Depuydt Pieter , Desai Mehul , Descamps Diane , Desvallées Mathilde , Dewayanti Santi , Dhangar Pathik , Diallo Alpha , Diamantis Sylvain , Dias André , Dias Da Silva Fernanda , Diaz Juan Jose , Diaz Rodrigo , Diaz Priscila , Dibba Bakary K , Didier Kévin , Diehl Jean-Luc , Dieperink Wim , Dimet Jérôme , Dinot Vincent , Diop Fara , Diouf Alphonsine , Dishon Yael , Djossou Félix , Docherty Annemarie B. , Doherty Helen , Dondorp Arjen M , Donnelly Christl A. , Donohue Sean , Donohue Yoann , Doran Peter , Dorival Céline , D'Ortenzio Eric , Doshi Yash , Douangdala Phouvieng , Douglas James Joshua , Douma Renee , Dournon Nathalie , Downey Joanne , Downing Mark , Drake Thomas , Driscoll Aoife , Dror Amiel A. , Dryden Murray , Duarte Fonseca Claudio , Dubee Vincent , Dubos François , Dubot-Pérès Audrey , Ducancelle Alexandre , Duculan Toni , Dudman Susanne , Duggal Abhijit , Dunand Paul , Dunning Jake , Duplaix Mathilde , Durante-Mangoni Emanuele , Durham III Lucian , Dussol Bertrand , Duthoit Juliette , Duval Xavier , Dyrhol-Riise Anne Margarita , Ean Sim Choon , Echeverria-Villalobos Marco , Edelstein Michael , Egan Siobhan , Eggesbø Linn Margrete , Eira Carla , El Sanharawi Mohammed , Elapavaluru Subbarao , Elharrar Brigitte , Ellerbroek Jacobien , Ellingjord-Dale Merete , Elotmani Loubna , Eloy Philippine , Elshazly Tarek , Elyazar Iqbal , Enderle Isabelle , Endo Tomoyuki , Eng Chan Chee , Engelmann Ilka , Enouf Vincent , Epaulard Olivier , Escher Martina , Esperatti Mariano , Esperou Hélène , Espírito Santo Catarina , Esposito-Farese Marina , Estevão João , Etienne Manuel , Everding Anna Greti , Evers Mirjam , Fabre Marc , Fabre Isabelle , Fadera Ismaila , Faheem Amna , Fahy Arabella , Fairfield Cameron J. , Faria Pedro , Fateena Hanan , Fatoni Arie Zainul , Faure Karine , Favory Raphaël , Fayed Mohamed , Feely Niamh , Fernandes Jorge , Fernandes Marília Andreia , Fernandes Susana , Ferrand François-Xavier , Ferrand Devouge Eglantine , Ferrão Joana , Ferraz Mário , Ferreira Sílvia , Ferreira Bernardo , Ferreira Benigno , Ferreira Isabel , Ferriere Nicolas , Ficko Céline , Figueiredo-Mello Claudia , Finlayson William , Flament Thomas , Fletcher Tom , Florence Aline-Marie , Florio Letizia Lucia , Flynn Deirdre , Flynn Brigid , Foley Jean , Fomin Victor , Fonseca Tatiana , Fontela Patricia , Forrest Karen , Forsyth Simon , Foster Denise , Foti Giuseppe , Fourn Erwan , Fowler Robert A. , Fraher Marianne , Franch-Llasat Diego , Fraser John F. , Fraser Christophe , Freire Marcela Vieira , Freitas Ribeiro Ana , Friedrich Caren , Fritz Ricardo , Fry Stéphanie , Fuentes Nora , Fukuda Masahiro , G Argin , Gaborieau Valérie , Gaci Rostane , Gagliardi Massimo , Gagnard Jean-Charles , Gagneux-Brunon Amandine , Gai Abdou , Gaião Sérgio , Gail Skeie Linda , Gallagher Phil , Gamble Carrol , Gani Yasmin , Garan Arthur , Garcia Rebekha , García Barrio Noelia , Garcia-Diaz Julia , Garcia-Gallo Esteban , Garimella Navya , Garot Denis , Garrait Valérie , Gavrylov Anatoliy , Gaymard Alexandre , Gebauer Johannes , Geraud Eva , Gerbaud Morlaes Louis , Germano Nuno , Ghisulal Praveen Kumar , Ghosn Jade , Giani Marco , Gigante Tristan , Gilroy Elaine , Giordano Guillermo , Girvan Michelle , Gissot Valérie , Glikman Daniel , Glybochko Petr , Gnall Eric , Goco Geraldine , Goehringer François , Goepel Siri , Goffard Jean-Christophe , Goh Jin Yi , Golob Jonathan , Gomes Rui , Gomez Kyle , Gómez-Junyent Joan , Gominet Marie , Gonzalez Alicia , Gordon Patricia , Gorelik Yanay , Gorenne Isabelle , Goubert Laure , Goujard Cécile , Goulenok Tiphaine , Grable Margarite , Graf Jeronimo , Grandin Edward Wilson , Granier Pascal , Grasselli Giacomo , Green Christopher A. , Greene Courtney , Greenhalf William , Greffe Segolène , Grieco Domenico Luca , Griffee Matthew , Griffiths Fiona , Grigoras Ioana , Groenendijk Albert , Gruner Heidi , Gu Yusing , Guedj Jérémie , Guego Martin , Guerguerian Anne-Marie , Guerreiro Daniela , Guery Romain , Guillaumot Anne , Guilleminault Laurent , Guimarães de Castro Maisa , Guimard Thomas , Haalboom Marieke , Haber Daniel , Hachemi Ali , Hadri Nadir , Hakak Sheeba , Hall Adam , Hall Matthew , Halpin Sophie , Hamer Ansley , Hamers Raph L. , Hamidfar Rebecca , Hammarström Bato , Hammond Terese , Hammond Naomi , Han Lim Yuen , Haniffa Rashan , Hao Kok Wei , Hardwick Hayley , Harrison Ewen M. , Harrison Janet , Harrison Samuel Bernard Ekow , Hartman Alan , Hashmi Junaid , Hayes Ailbhe , Hays Leanne , Heerman Jan , Heggelund Lars , Hendry Ross , Hennessy Martina , Henriquez-Trujillo Aquiles Rodrigo , Hentzien Maxime , Hernandez Diana , Herr Daniel , Hershey Andrew , Hesstvedt Liv , Hidayah Astarini , Higgins Eibhlin , Higgins Rupert , Hinton Samuel , Hiraiwa Hiroaki , Hirkani Haider , Hitoto Hikombo , Ho Antonia , Ho Yi Bin , Hoctin Alexandre , Hoffmann Isabelle , Hoh Wei Han , Hoiting Oscar , Holt Rebecca , Holter Jan Cato , Horby Peter , Horcajada Juan Pablo , Houas Ikram , Hough Catherine L. , Houltham Stuart , Hsu Jimmy Ming-Yang , Hulot Jean-Sébastien , Huo Stella , Hurd Abby , Ijaz Samreen , Ikram M. Arfan , Illana Carlos Cañada , Imbert Patrick , Inácio Hugo , Infante Dominguez Carmen , Ing Yun Sii , Iosifidis Elias , Ippolito Mariachiara , Isgett Sarah , Isidoro Tiago , Ismail Nadiah , Isnard Margaux , Istre Mette Stausland , Itai Junji , Ivulich Daniel , Jaafar Danielle , Jaafoura Salma , Jabot Julien , Jackson Clare , Jagne Abubacarr , Janes Victoria , Jaureguiberry Stéphane , Jaworsky Denise , Jego Florence , Jelani Anilawati Mat , Jenum Synne , Jimbo-Sotomayor Ruth , Joe Ong Yiaw , Jorge García Ruth Noemí , Jørgensen Silje Bakken , Joseph Mark , Joseph Cédric , Joshi Swosti , Jourdain Mercé , Jouvet Philippe , Jung Anna , Jung Hanna , Juzar Dafsah , Kafif Ouifiya , Kaguelidou Florentia , Kaisbain Neerusha , Kaleesvran Thavamany , Kali Sabina , Kalicinska Alina , Kalleberg Karl Trygve , Kalomoiri Smaragdi , Kamaluddin Muhammad Aisar Ayadi , Kamaruddin Zul Amali Che , Kamarudin Nadiah , Kandamby Darshana Hewa , Kang Kong Yeow , Kanyawati Dyah , Karpayah Pratap , Kartsonaki Christiana , Kasugai Daisuke , Katz Kevin , Kay Christy , Kayyali Lamees , Keating Seán , Kedia Pulak , Kelly Claire , Kelly Yvelynne , Kelly Andrea , Kelly Niamh , Kelly Aoife , Kelly Sadie , Kelsey Maeve , Kennon Kalynn , Keomany Sommay , Kernan Maeve , Kerroumi Younes , Keshav Sharma , Khalid Imrana , Khalil Antoine , Khan Irfan , Kherajani Krish , Kho Michelle E. , Khoo Saye , Khoo Ryan , Khoo Denisa , Kiat Khor How , Kida Yuri , Kiiza Peter , Kiland Granerud Beathe , Kildal Anders Benjamin , Kim Jae Burm , Kimmoun Antoine , Kindgen-Milles Detlef , Kitamura Nobuya , Kjetland Eyrun Floerecke Kjetland , Klenerman Paul , Klont Rob , Kloumann Bekken Gry , Knight Stephen R , Kobbe Robin , Kodippily Chamira , Kohns Vasconcelos Malte , Komatsu Mamoru , Korten Volkan , Kpangon Arsène , Krawczyk Karolina , Krishnan Sudhir , Krishnan Vinothini , Kruglova Oksana , Kuan Pei Xuan , Kumar Deepali , Kumar Ganesh , Kuriakose Dinesh , Kurtzman Ethan , Kusumastuti Neurinda Permata , Kutsogiannis Demetrios , Kutsyna Galyna , Kyriakoulis Konstantinos , Lachatre Marie , Lacoste Marie , Laffey John G. , Lafhej Nadhem , Lagrange Marie , Laine Fabrice , Lairez Olivier , Lalueza Antonio , Lambert Marc , Langelot-Richard Marie , Langlois Vincent , Lantang Eka Yudha , Lanza Marina , Laouénan Cédric , Laribi Samira , Lariviere Delphine , Lasry Stéphane , Lath Sakshi , Launay Odile , Laureillard Didier , Lavie-Badie Yoan , Law Andy , Lawrence Teresa , Lawrence Cassie , Le Minh , Le Bihan Clément , Le Bris Cyril , Le Falher Georges , Le Fevre Lucie , Le Hingrat Quentin , Le Maréchal Marion , Le Mestre Soizic , Le Moal Gwenaël , Le Moing Vincent , Le Nagard Hervé , Leal Ema , Leal Santos Marta , Lee Todd C. , Lee Su Hwan , Lee James , Lee Heng Gee , Lee Biing Horng , Lee Yi Lin , Lee Jennifer , Leeming Gary , Lefebvre Laurent , Lefebvre Bénédicte , Lefèvre Benjamin , LeGac Sylvie , Lelievre Jean-Daniel , Lellouche François , Lemaignen Adrien , Lemee Véronique , Lemeur Anthony , Lemmink Gretchen , Lene Ha Sha , Lennon Jenny , León Rafael , Leone Marc , Lepiller Quentin , Lescure François-Xavier , Lesens Olivier , Lesouhaitier Mathieu , Lester-Grant Amy , Letizia Andrew , Letrou Sophie , Levy Yves , Levy Bruno , Levy-Marchal Claire , Lewandowska Katarzyna , L'Her Erwan , Li Bassi Gianluigi , Liang Janet , Liegeon Geoffrey , Lim Wei Shen , Lim Kah Chuan , Lima Chantre , Lina Lim , Lina Bruno , Lind Andreas , Lingad Maja Katherine , Lingas Guillaume , Lion-Daolio Sylvie , Lissauer Samantha , Liu Keibun , Livrozet Marine , Lizotte Patricia , Loforte Antonio , Lolong Navy , Loon Leong Chee , Lopes Diogo , Lopez-Colon Dalia , Lopez-Revilla Jose W. , Loschner Anthony L. , Loubet Paul , Loufti Bouchra , Louis Guillame , Lourenco Silvia , Lovelace-Macon Lara , Low Lee Lee , Lowik Marije , Loy Jia Shyi , Lucet Jean Christophe , Lumbreras Bermejo Carlos , Luna Carlos M. , Lungu Olguta , Lunn Miles , Luong Liem , Luque Nestor , Luton Dominique , Maasikas Olavi , Machado Sara , Machado Moïse , Macheda Gabriel , Maestro de la Calle Guillermo , Mahieu Rafael , Mahy Sophie , Maia Ana Raquel , Maier Lars S. , Maillet Mylène , Maitre Thomas , Malfertheiner Maximilian , Malik Nadia , Mallon Paddy , Maltez Fernando , Malvy Denis , Manda Victoria , Mandei Jose M. , Mandelbrot Laurent , Manetta Frank , Mankikian Julie , Manning Edmund , Manuel Aldric , Maria Sant`Ana Malaque Ceila , Marino Flávio , Markowicz Samuel , Marques Ana , Marquis Catherine , Marsh Brian , Marshal Megan , Marshall John , Martelli Celina Turchi , Martin Dori-Ann , Martin Emily , Martin-Blondel Guillaume , Martinez F. Eduardo , Martinot Martin , Martín-Quiros Alejandro , Martins João , Martins Ana , Martins Nuno , Martins Rego Caroline , Martucci Gennaro , Martynenko Olga , Marwali Eva Miranda , Marzukie Marsilla , Maslove David , Mason Sabina , Matan Moshe , Mateus Fernandes Henrique , Mattei Mathieu , Maulin Laurence , Maynar Javier , Mayxay Mayfong , Mazzoni Thierry , Mc Sweeney Lisa , McArthur Colin , McCann Naina , McCanny Peter , McCarthy Anne , McCarthy Aine , McCloskey Colin , McConnochie Rachael , McDermott Sherry , McDonald Sarah E. , McElroy Aine , McElwee Samuel , McEvoy Natalie , McGeer Allison , McLean Kenneth A. , McNally Paul , McNicholas Bairbre , Meaney Edel , Mear-Passard Cécile , Mechlin Maggie , Mehkri Omar , Mele Ferruccio , Melo Luis , Mendes João João , Menkiti Ogechukwu , Menon Kusum , Mentré France , Mentzer Alexander J. , Mercier Noémie , Mercier Emmanuelle , Merckx Antoine , Mergeay-Fabre Mayka , Mergler Blake , Mesquita António , Meta Roberta , Metwally Osama , Meybeck Agnès , Meyer Dan , Meynert Alison M. , Meysonnier Vanina , Mezidi Mehdi , Michelanglei Céline , Michelet Isabelle , Mihelis Efstathia , Mihnovit Vladislav , Miller Jennene , Miranda-Maldonado Hugo , Misnan Nor Arisah , Mohamed Tahira Jamal , Mohamed Nik Nur Eliza , Moin Asma , Molinos Elena , Molloy Brenda , Mone Mary , Monteiro Agostinho , Montes Claudia , Montrucchio Giorgia , Moore Shona C. , Moore Sarah , Morales Cely Lina , Moro Lucia , Morton Ben , Motherway Catherine , Motos Ana , Mouquet Hugo , Mouton Perrot Clara , Moyet Julien , Mudara Caroline , Muh Ng Yong , Muhamad Dzawani , Mullaert Jimmy , Müller Fredrik , Müller Karl Erik , Munblit Daniel , Munshi Laveena , Murphy Aisling , Murray Patrick , Murris Marlène , Murthy Srinivas , Musaab Himed , Muvindi Himasha , Myrodia Dimitra Melia , Nadjm Behzad , Nagpal Dave , Nagrebetsky Alex , Narasimhan Mangala , Narayanan Nageswaran , Nazerali-Maitland Alasdair , Neant Nadège , Neb Holger , Nekliudov Nikita , Nelder Matthew , Nelwan Erni , Neto Raul , Neumann Emily , Ng Pauline Yeung , Ng Wing Yiu , Nghi Anthony , Nguyen Duc , Ni Choileain Orna , Ni Leathlobhair Niamh , Nichol Alistair D , Nitayavardhana Prompak , Nonas Stephanie , Noordin Nurul Amani Mohd , Norharizam Nurul Faten Izzati , Notari Alessandra , Noursadeghi Mahdad , Nowinski Adam , Nseir Saad , Nurnaningsih Nurnaningsih , Nusantara Dwi Utomo , Nyamankolly Elsa , Nygaard Anders Benteson , O Brien Fionnuala , O Callaghan Annmarie , Occhipinti Giovanna , OConnor Derbrenn , O'Donnell Max , Ogston Tawnya , Ogura Takayuki , Oh Tak-Hyuk , O'Halloran Sophie , O'Hearn Katie , Oldakowska Agnieszka , Oliveira João , Olliaro Piero L. , Ong David S. Y. , Ong Jee Yan , Oosthuyzen Wilna , Opavsky Anne , Openshaw Peter , Orozco-Chamorro Claudia Milena , Ortoleva Jamel , Osatnik Javier , O'Shea Linda , O'Sullivan Miriam , Othman Siti Zubaidah , Otiku Paul , Ouamara Nadia , Ouissa Rachida , Oziol Eric , Pagadoy Maïder , Pages Justine , Palmarini Massimo , Panarello Giovanna , Panda Prasan Kumar , Pang Lai Hui , Panigada Mauro , Pansu Nathalie , Papadopoulos Aurélie , Parke Rachael , Parker Melissa , Pasquier Jérémie , Pastene Bruno , Patauner Fabian , Patel Drashti , Pathmanathan Mohan Dass , Patrão Luís , Patricio Patricia , Patterson Lisa , Paul Mical , Paul Christelle , Paulos Jorge , Paxton William A. , Payen Jean-François , Peake Sandra L , Peariasamy Kalaiarasu , Pedrera Jiménez Miguel , Peek Giles J. , Peelman Florent , Peiffer-Smadja Nathan , Peigne Vincent , Pejkovska Mare , Pelosi Paolo , Peltan Ithan D. , Pereira Rui , Perez Daniel , Perpoint Thomas , Pesenti Antonio , Pestre Vincent , Petrou Lenka , Petrovic Michele , Petrov-Sanchez Ventzislava , Pettersen Frank Olav , Peytavin Gilles , Phonemixay Ooyanong , Phoutthavong Soulichanya , Piagnerelli Michael , Picard Walter , Picone Olivier , Piero Maria de , Piersma Djura , Pimentel Carlos , Pinto Raquel , Pires Catarina , Piroth Lionel , Pitaloka Ayodhia , Piubelli Chiara , Pius Riinu , Piva Simone , Plantier Laurent , Png Hon Shen , Poissy Julien , Pokeerbux Ryadh , Pokorska-Spiewak Maria , Poli Sergio , Pollakis Georgios , Ponscarme Diane , Popielska Jolanta , Porto Diego Bastos , Post Andra-Maris , Postma Douwe F. , Povoa Pedro , Póvoas Diana , Powis Jeff , Prapa Sofia , Praphasiri Viladeth , Preau Sébastien , Prebensen Christian , Preiser Jean-Charles , Prinssen Anton , Pritchard Mark G. , Priyadarshani Gamage Dona Dilanthi , Proença Lucia , Pudota Sravya , Pujo Semedi Bambang , Quesada Luisa , Quinones-Cardona Vilmaris , Quirós González Víctor , Quist-Paulsen Else , Quraishi Mohammed , Qutishat Fadi , Rabaa Maia , Rabaud Christian , Rafael Aldo , Rafiq Marie , Rahardjani Mutia , Rahman Rozanah Abd , Rahman Ahmad Kashfi Haji Ab , Rainieri Fernando , Rajahram Giri Shan , Ramakrishnan Nagarajan , Ramalho José , Ramli Ahmad Afiq , Rammaert Blandine , Ramos Grazielle Viana , Rangappa Rajavardhan , Ranjan Ritika , Rapp Christophe , Rashan Aasiyah , Rashan Thalha , Rasmin Menaldi , Rätsep Indrek , Rau Cornelius , Ravi Tharmini , Real Andre , Rebaudet Stanislas , Redl Sarah , Reeve Brenda , Reikvam Dag Henrik , Reis Renato , Rello Jordi , Remppis Jonathan , Remy Martine , Ren Hongru , Renk Hanna , Resseguier Anne-Sophie , Revest Matthieu , Rewa Oleksa , Reyes Luis Felipe , Ribeiro Maria Ines , Ricchiuto Antonia , Richardson David , Richardson Denise , Richier Laurent , Ridzuan Siti Nurul Atikah Ahmad , Rios Ana L , Rishu Asgar , Rispal Patrick , Risso Karine , Rivera Nuñez Maria Angelica , Robba Chiara , Roberto André , Roberts Charles , Robertson David L. , Robineau Olivier , Roca Anna , Roche-Campo Ferran , Rodari Paola , Rodeia Simão , Roessler Bernhard , Roger Claire , Roger Pierre-Marie , Roilides Emmanuel , Rojek Amanda , Roncon-Albuquerque Roberto , Roriz Mélanie , Rosa-Calatrava Manuel , Rose Michael , Rosenberger Dorothea , Rossanese Andrea , Rossetti Matteo , Rossignol Patrick , Roy Carine , Roze Benoît , Rusmawatiningtyas Desy , Russell Clark D. , Ryan Maeve , Ryckaert Steffi , Rygh Holten Aleksander , Saba Isabela , Sadat Musharaf , Sahraei Valla , Sakiyalak Pranya , Salazar Leonardo , Sales Gabriele , Salmon Gandonniere Charlotte , Salvator Hélène , Sanchez Emely , Sanchez Olivier , Sanchez de Oliveira Kizy , Sanchez-Miralles Angel , Sancho-Shimizu Vanessa , Sandhu Gyan , Sandhu Zulfiqar , Sandrine Pierre-François , Santos Marlene , Sarfo-Mensah Shirley , Sarmento Banheiro Bruno , Sarmiento Iam Claire E. , Sarton Benjamine , Satya Ankana , Satyapriya Sree , Satyawati Rumaisah , Saviciute Egle , Savvidou Parthena , Saw Yen Tsen , Schaffer Justin , Schermer Tjard , Scherpereel Arnaud , Schneider Marion , Schwameis Michael , Schwartz Gary , Scott Janet T. , Scott-Brown James , Sedillot Nicholas , Seitz Tamara , Selvarajoo Mageswari , Semple Malcolm G. , Senian Rasidah Bt , Senneville Eric , Sepulveda Claudia , Sequeira Filipa , Sequeira Tânia , Serpa Neto Ary , Serrano Balazote Pablo , Shadowitz Ellen , Shahidan Syamin Asyraf , Shankar Anuraj , Sharjeel Shaikh , Sharma Pratima , Shaw Catherine A. , Shaw Victoria , Sheenan John Robert , Shetty Rohan , Shetty Dr. Rajesh Mohan , Shiekh Mohiuddin , Shime Nobuaki , Shimizu Hiroaki , Shimizu Keiki , Shrapnel Sally , Shum Hoi Ping , Si Mohammed Nassima , Siang Ng Yong , Sibiude Jeanne , Sibounheuang Bountoy , Siddiqui Atif , Sigfrid Louise , Sillah Fatoumata , Sillaots Piret , Silva Catarina , Silva Rogério , Silva Maria Joao , Sim Lim Heng Benedict , Sin Wai Ching , Sinatti Dario , Singh Punam , Singh Mahendra , Sitompul Pompini Agustina , Sivam Karisha , Skogen Vegard , Smith Sue , Smood Benjamin , Smyth Coilin , Snacken Morgane , So Dominic , Soh Tze Vee , Solberg Lene Bergendal , Solomon Joshua , Solomon Tom , Somers Emily , Sommet Agnès , Song Rima , Song Myung Jin , Song Tae , Song Chia Jack , Søraas Arne , Sotto Albert , Soum Edouard , Sousa Marta , Sousa Ana Chora , Sousa Uva Maria , Souza-Dantas Vicente , Sperry Alexandra , Spinuzza Elisabetta , Sri Darshana B. P. Sanka Ruwan , Sriskandan Shiranee , Stabler Sarah , Staudinger Thomas , Stecher Stephanie-Susanne , Steinsvik Trude , Stienstra Ymkje , Stiksrud Birgitte , Stolz Eva , Stone Amy , Streinu-Cercel Adrian , Streinu-Cercel Anca , Stuart Ami , Stuart David , Su Richa , Subekti Decy , Suen Gabriel , Suen Jacky Y. , Sukumar Prasanth , Sultana Asfia , Summers Charlotte , Supic Dubravka , Suppiah Deepashankari , Surovcová Magdalena , Suwarti Atie , Svistunov Andrey , Syahrin Sarah , Syrigos Konstantinos , Sztajnbok Jaques , Szuldrzynski Konstanty , Tabrizi Shirin , Taccone Fabio S. , Tagherset Lysa , Taib Shahdattul Mawarni , Talarek Ewa , Taleb Sara , Talsma Jelmer , Tamisier Renaud , Tampubolon Maria Lawrensia , Tan Kim Keat , Tan Yan Chyi , Tanaka Hiroyuki , Tanaka Taku , Taniguchi Hayato , Tardivon Coralie , Tattevin Pierre , Taufik M Azhari , Tawfik Hassan , Tee Tze Yuan , Teixeira João , Tejada Sofia , Tellier Marie-Capucine , Teoh Sze Kye , Teotonio Vanessa , Téoulé François , Terrier Olivier , Terzi Nicolas , Tessier-Grenier Hubert , Tey Adrian , Thabit Alif Adlan Mohd , Tham Zhang Duan , Thangavelu Suvintheran , Theron Elmi , Thibault Vincent , Thiberville Simon-Djamel , Thill Benoît , Thirumanickam Jananee , Thompson Shaun , Thompson Niamh , Thomson David , Thomson Emma C. , Thorpe Mathew , Thurai Surain Raaj Thanga , Thwaites Ryan S. , Tierney Paul , Tieroshyn Vadim , Timashev Peter S , Timsit Jean-François , Tissot Noémie , Toal Fiona , Toh Jordan Zhien Yang , Toki Maria , Tonby Kristian , Tonnii Sia Loong , Torre Marta , Torres Margarida , Torres Antoni , Torres Santos-Olmo Rosario Maria , Torres-Zevallos Hernando , Towers Michael , Trapani Tony , Tromeur Cécile , Trontzas Ioannis , Trouillon Tiffany , Truong Jeanne , Tual Christelle , Tubiana Sarah , Tuite Helen , Turgeon Alexis F. , Turmel Jean-Marie , Turtle Lance C.W. , Tveita Anders , Twardowski Pawel , Uchiyama Makoto , Udayanga PG Ishara , Udy Andrew , Ullrich Roman , Uribe Alberto , Usman Asad , Uyeki Timothy M. , Vaillant Michel , Vajdovics Cristinava , Valentini Piero , Val-Flores Luís , Van de Velde Stijn , van den Berge Marcel , van der Feltz Machteld , van der Palen Job , van der Valk Paul , Van Der Vekens Nicky , Van der Voort Peter , Van Der Werf Sylvie , van Gulik Laura , Van Hattem Jarne , van Netten Carolien , van Someren Gréve Frank , van Veen Ilonka , Van Willigen Hugo , Vanel Noémie , Vanoverschelde Henk , Varrone Michael , Vasudayan Shoban Raj , Vauchy Charline , Vecham Pavan Kumar , Veeran Shaminee , Veislinger Aurélie , Vencken Sebastian , Ventura Sara , Verbon Annelies , Vidal José Ernesto , Vieira César , Villar Judit , Villeneuve Pierre-Marc , Villoldo Andrea , Vishwanathan Gayatri , Visseaux Benoit , Visser Hannah , Vitiello Chiara , Vongsouvath Manivanh , Vonkeman Harald , Vuotto Fanny , Wahab Noor Hidayu , Wahab Suhaila Abdul , Wahid Nadirah Abdul , Wainstein Marina , Walsh Laura , Wang Chih-Hsien , Webb Steve , Wei Jia , Weil Katharina , Wen Tan Pei , Wesselius Sanne , West T. Eoin , Wham Murray , Whelan Bryan , White Nicole , Wicky Paul Henri , Wiedemann Aurélie , Wijaya Surya Otto , Wille Keith , Willems Sue , Williams Bailey , Williams Virginie , Williams Patricia J , Wittman Jessica , Wong Calvin , Wong Xin Ci , Wong Yew Sing , Wong Teck Fung , Wright Natalie , Xian Lim Saio , Xynogalas Ioannis , Yakop Siti Rohani Binti Mohd , Yamazaki Masaki , Yarad Elizabeth , Yazdanpanah Yazdan , Yee Liang Hing Nicholas , Yelnik Cécile , Yeoh Chian Hui , Yerkovich Stephanie , Yiaye Touxiong , Yokoyama Toshiki , Yonis Hodane , Yousif Obada , Yuliarto Saptadi , Zaaqoq Akram , Zabbe Marion , Zacharowski Kai , Zahid Masliza , Zahran Maram , Zaidan Nor Zaila Binti , Zambon Maria , Zambrano Miguel , Zanella Alberto , Zawadka Konrad , Zaynah Nurul , Zayyad Hiba , Zoufaly Alexander , Zucman David 
Published: December 2023

Importance

Research diversity and representativeness are paramount in building trust, generating valid biomedical knowledge, and possibly in implementing clinical guidelines.

Objectives

To compare variations over time and across World Health Organization (WHO) geographic regions of corticosteroid use for treatment of severe COVID-19; secondary objectives were to evaluate the association between the timing of publication of the RECOVERY (Randomised Evaluation of COVID-19 Therapy) trial (June 2020) and the WHO guidelines for corticosteroids (September 2020) and the temporal trends observed in corticosteroid use by region and to describe the geographic distribution of the recruitment in clinical trials that informed the WHO recommendation.

Design, Setting, and Participants

This prospective cohort study of 434 851 patients was conducted between January 31, 2020, and September 2, 2022, in 63 countries worldwide. The data were collected under the auspices of the International Severe Acute Respiratory and Emerging Infections Consortium (ISARIC)–WHO Clinical Characterisation Protocol for Severe Emerging Infections. Analyses were restricted to patients hospitalized for severe COVID-19 (a subset of the ISARIC data set).

Exposure

Corticosteroid use as reported to the ISARIC-WHO Clinical Characterisation Protocol for Severe Emerging Infections.

Main Outcomes and Measures

Number and percentage of patients hospitalized with severe COVID-19 who received corticosteroids by time period and by WHO geographic region.

Results

Among 434 851 patients with confirmed severe or critical COVID-19 for whom receipt of corticosteroids could be ascertained (median [IQR] age, 61.0 [48.0-74.0] years; 53.0% male), 174 307 (40.1%) received corticosteroids during the study period. Of the participants in clinical trials that informed the guideline, 91.6% were recruited from the United Kingdom. In all regions, corticosteroid use for severe COVID-19 increased, but this increase corresponded to the timing of the RECOVERY trial (time-interruption coefficient 1.0 [95% CI, 0.9-1.2]) and WHO guideline (time-interruption coefficient 1.9 [95% CI, 1.7-2.0]) publications only in Europe. At the end of the study period, corticosteroid use for treatment of severe COVID-19 was highest in the Americas (5421 of 6095 [88.9%]; 95% CI, 87.7-90.2) and lowest in Africa (31 588 of 185 191 [17.1%]; 95% CI, 16.8-17.3).

Conclusions and Relevance

The results of this cohort study showed that implementation of the guidelines for use of corticosteroids in the treatment of severe COVID-19 varied geographically. Uptake of corticosteroid treatment was lower in regions with limited clinical trial involvement. Improving research diversity and representativeness may facilitate timely knowledge uptake and guideline implementation.