Adjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trial
Abstract Background Several trials and meta-analyses found a benefit of adjunct corticosteroids for community-acquired pneumonia with respect to short-term outcome, but there is uncertainty about longer-term health effects. Herein, we evaluated clinical outcomes at long term in patients participatin...
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| Format: | Article |
| Language: | English |
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BMC
2023-12-01
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| Series: | BMC Pulmonary Medicine |
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| Online Access: | https://doi.org/10.1186/s12890-023-02794-w |
| _version_ | 1797388574004346880 |
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| author | Claudine A. Blum Eva A. Roethlisberger Nicole Cesana-Nigro Bettina Winzeler Nicolas Rodondi Manuel R. Blum Matthias Briel Beat Mueller Mirjam Christ-Crain Philipp Schuetz |
| author_facet | Claudine A. Blum Eva A. Roethlisberger Nicole Cesana-Nigro Bettina Winzeler Nicolas Rodondi Manuel R. Blum Matthias Briel Beat Mueller Mirjam Christ-Crain Philipp Schuetz |
| author_sort | Claudine A. Blum |
| collection | DOAJ |
| description | Abstract Background Several trials and meta-analyses found a benefit of adjunct corticosteroids for community-acquired pneumonia with respect to short-term outcome, but there is uncertainty about longer-term health effects. Herein, we evaluated clinical outcomes at long term in patients participating in the STEP trial (Corticosteroid Treatment for Community-Acquired Pneumonia). Methods This predefined secondary analysis investigated 180-day outcomes in 785 adult patients hospitalized with community-acquired pneumonia included in STEP, a randomised, placebo-controlled, double-blind trial. The primary endpoint was time to death from any cause at 180 days verified by telephone interview. Additional secondary endpoints included pneumonia-related death, readmission, recurrent pneumonia, secondary infections, new hypertension, and new insulin dependence. Results From the originally included 785 patients, 727 were available for intention-to-treat analysis at day 180. There was no difference between groups with respect to time to death from any cause (HR for corticosteroid use 1.15, 95% CI 0.68 to 1.95, p = 0.601). Compared to placebo, corticosteroid-treated patients had significantly higher risks for recurrent pneumonia (OR 2.57, 95% CI 1.29 to 5.12, p = 0.007), secondary infections (OR 1.94, 95% CI 1.25 to 3.03, p = 0.003) and new insulin dependence (OR 8.73, 95% CI 1.10 to 69.62, p = 0.041). There was no difference regarding pneumonia-related death, readmission and new hypertension. Conclusions In patients with community-acquired pneumonia, corticosteroid use was associated with an increased risk for recurrent pneumonia, secondary infections and new insulin dependence at 180 days. Currently, it is uncertain whether these long-term adverse effects outweigh the short-term effects of corticosteroids in moderate CAP. Trial registration This trial was registered with ClinicalTrials. gov, number NCT00973154 before the recruitment of the first patient. First posted: September 9, 2009. Last update posted: April 21, 2015. |
| first_indexed | 2024-03-08T22:42:47Z |
| format | Article |
| id | doaj.art-e7c13ba4ed6e475fae45dea938d10faf |
| institution | Directory Open Access Journal |
| issn | 1471-2466 |
| language | English |
| last_indexed | 2024-03-08T22:42:47Z |
| publishDate | 2023-12-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Pulmonary Medicine |
| spelling | doaj.art-e7c13ba4ed6e475fae45dea938d10faf2023-12-17T12:05:37ZengBMCBMC Pulmonary Medicine1471-24662023-12-0123111210.1186/s12890-023-02794-wAdjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trialClaudine A. Blum0Eva A. Roethlisberger1Nicole Cesana-Nigro2Bettina Winzeler3Nicolas Rodondi4Manuel R. Blum5Matthias Briel6Beat Mueller7Mirjam Christ-Crain8Philipp Schuetz9Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital BaselMedical University Clinic, Division of General Internal & Emergency Medicine and Division of Endocrinology, Diabetology and Metabolism, Kantonsspital AarauEndocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital BaselEndocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital BaselInstitute of Primary Health Care (BIHAM), University of BernInstitute of Primary Health Care (BIHAM), University of BernCLEAR-Methods Center, Division of Clinical Epidemiology, Department of Clinical Research, University Hospital Basel and University of BaselMedical University Clinic, Division of General Internal & Emergency Medicine and Division of Endocrinology, Diabetology and Metabolism, Kantonsspital AarauEndocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital BaselMedical University Clinic, Division of General Internal & Emergency Medicine and Division of Endocrinology, Diabetology and Metabolism, Kantonsspital AarauAbstract Background Several trials and meta-analyses found a benefit of adjunct corticosteroids for community-acquired pneumonia with respect to short-term outcome, but there is uncertainty about longer-term health effects. Herein, we evaluated clinical outcomes at long term in patients participating in the STEP trial (Corticosteroid Treatment for Community-Acquired Pneumonia). Methods This predefined secondary analysis investigated 180-day outcomes in 785 adult patients hospitalized with community-acquired pneumonia included in STEP, a randomised, placebo-controlled, double-blind trial. The primary endpoint was time to death from any cause at 180 days verified by telephone interview. Additional secondary endpoints included pneumonia-related death, readmission, recurrent pneumonia, secondary infections, new hypertension, and new insulin dependence. Results From the originally included 785 patients, 727 were available for intention-to-treat analysis at day 180. There was no difference between groups with respect to time to death from any cause (HR for corticosteroid use 1.15, 95% CI 0.68 to 1.95, p = 0.601). Compared to placebo, corticosteroid-treated patients had significantly higher risks for recurrent pneumonia (OR 2.57, 95% CI 1.29 to 5.12, p = 0.007), secondary infections (OR 1.94, 95% CI 1.25 to 3.03, p = 0.003) and new insulin dependence (OR 8.73, 95% CI 1.10 to 69.62, p = 0.041). There was no difference regarding pneumonia-related death, readmission and new hypertension. Conclusions In patients with community-acquired pneumonia, corticosteroid use was associated with an increased risk for recurrent pneumonia, secondary infections and new insulin dependence at 180 days. Currently, it is uncertain whether these long-term adverse effects outweigh the short-term effects of corticosteroids in moderate CAP. Trial registration This trial was registered with ClinicalTrials. gov, number NCT00973154 before the recruitment of the first patient. First posted: September 9, 2009. Last update posted: April 21, 2015.https://doi.org/10.1186/s12890-023-02794-wCommunity-acquired pneumoniaCorticosteroidsGlucocorticoidsPrednisoneLower respiratory tract infections |
| spellingShingle | Claudine A. Blum Eva A. Roethlisberger Nicole Cesana-Nigro Bettina Winzeler Nicolas Rodondi Manuel R. Blum Matthias Briel Beat Mueller Mirjam Christ-Crain Philipp Schuetz Adjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trial BMC Pulmonary Medicine Community-acquired pneumonia Corticosteroids Glucocorticoids Prednisone Lower respiratory tract infections |
| title | Adjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trial |
| title_full | Adjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trial |
| title_fullStr | Adjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trial |
| title_full_unstemmed | Adjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trial |
| title_short | Adjunct prednisone in community-acquired pneumonia: 180-day outcome of a multicentre, double-blind, randomized, placebo-controlled trial |
| title_sort | adjunct prednisone in community acquired pneumonia 180 day outcome of a multicentre double blind randomized placebo controlled trial |
| topic | Community-acquired pneumonia Corticosteroids Glucocorticoids Prednisone Lower respiratory tract infections |
| url | https://doi.org/10.1186/s12890-023-02794-w |
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