Corticosteroids with or without antiviral therapy in elderly patients hospitalized with COVID-19 during the Omicron era: A multicenter real-world study

BACKGROUND: Elderly patients remain at high risk for adverse outcomes from COVID-19 despite the generally reduced pathogenicity of the Omicron variant. Corticosteroids are commonly used in hospitalized patients with COVID-19, particularly in those with more severe disease, while antiviral agents inhibit viral replication. However, evidence comparing corticosteroid monotherapy with corticosteroid-antiviral combination therapy in elderly hospitalized patients remains limited. METHODS: This multicenter retrospective cohort study included hospitalized patients aged ≥60 years with laboratory-confirmed COVID-19 at two tertiary hospitals in China, all of whom received systemic corticosteroid therapy during hospitalization. Patients were classified into either a corticosteroid monotherapy group or corticosteroid-antiviral combination therapy group. To reduce confounding, inverse probability of treatment weighting (IPTW) based on propensity scores was applied. The primary outcome was all-cause in-hospital mortality, and mechanical ventilation was assessed as a secondary outcome. RESULTS: A total of 624 elderly hospitalized patients with COVID-19 who received systemic corticosteroid therapy were included in the IPTW analysis (290 in the corticosteroid group and 334 in the combination therapy group). After weighting, baseline characteristics were well balanced between groups. The weighted incidence of in-hospital mortality was lower in the combination therapy group than in the corticosteroid monotherapy group (8.09% vs 13.47%; OR 0.566, 95% CI 0.333-0.961; p = 0.035). No statistically significant difference was observed in the risk of mechanical ventilation between groups (OR 1.286, 95% CI 0.924-1.789; p = 0.136). CONCLUSIONS: Among elderly hospitalized patients with COVID-19 during the Omicron period who received systemic corticosteroid therapy corticosteroids combined with antiviral therapy were associated with lower in-hospital mortality compared with corticosteroid monotherapy, while no significant difference was observed in mechanical ventilation.