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 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.

Clinicoepidemiological Profile of Recurrent Pneumonia in Children

“…That was considered statistically nonsignificant. In contrast to our study, Blum et al (32) stated that cortisone therapy is significant predisposing factor for RP with P = 0.007%. Also, much researches assessing adverse effects after short-term prescription of corticosteroids have demonstrated an increase of secondary infections even beyond day 30 (33) .…”

Low-Dose Corticosteroids for Critically Ill Adults With Severe Pulmonary Infections

“…A meta-analysis of 4 studies of 1000 patients with severe CAP also reported no association between low-dose corticosteroids and risk of secondary health care–associated infections in the ICU (8% vs 10%; relative risk, 0.89; 95% CI, 0.60-1.32). However, a 180-day follow-up of 727 patients enrolled in the STEP trial (corticosteroids for CAP) demonstrated a higher risk of recurrent pneumonia (8% vs 3%; OR, 2.57; 95% CI, 1.29-5.12) and secondary infections such as dermatologic, urogenital, pulmonary, intestinal, and endocardium/foreign body infections (17% vs 10%; OR, 1.94, 95% CI, 1.25-3.03) with corticosteroids . A meta-analysis of 9 studies reported a significantly lower risk of nosocomial infections in 2311 patients with COVID-19 treated with dexamethasone 12 vs 6 mg daily (absolute risk difference, −16.7 per 1000; 95% CI, −25 to −5.4; very low certainty) .…”

“…However, a 180-day follow-up of 727 patients enrolled in the STEP trial (corticosteroids for CAP) demonstrated a higher risk of recurrent pneumonia (8% vs 3%; OR, 2.57; 95% CI, 1.29-5.12) and secondary infections such as dermatologic, urogenital, pulmonary, intestinal, and endocardium/ foreign body infections (17% vs 10%; OR, 1.94, 95% CI, 1.25-3.03) with corticosteroids. 71 A meta-analysis of 9 studies reported a significantly lower risk of nosocomial infections in 2311 patients with COVID-19 treated with dexamethasone 12 vs 6 mg daily (absolute risk difference, −16.7 per 1000; 95% CI, −25 to −5.4; very low certainty). 25 However, data from retrospective studies and case series suggested that patients with COVID-19 treated with high doses of corticosteroids were at increased risk of nocardiosis, 72 mucormycosis, and pulmonary aspergillosis.…”