Table 1.
RCT evaluating the use of glucocorticoids in community-acguired pneumonia
| Study, year, journal | Study design | Drug and dose | Sample size | Inclusion criteria | Primary outcome | Results (primary outcome) | Secondary outcome results | Adverse effects |
|---|---|---|---|---|---|---|---|---|
| Wittermans et al, 2021, Eur Resplr J15 | Double-blind, placebo-controlled, RCT 1:1 | DXM (6 mg qd) vs. placebo for 4 d | 401 | Adult CAP Immunocompetent | Median length of stay (days) | Achieved. 4.5 (4.0–5.0) d in DXM group vs. 5.0 (4.6–5.4) d in placebo group, p = 0.033 |
Significant reduction in secondary ICU admission rate in the DXM group. | Hyperglycemia |
| Torres et al, 2015, JAMA16 | Double-blind, placebo-controlled, RCT 1:1 | MP (0.5 mg/kg for 5 d) vs. placebo | 120 | Adult Symptoms New chest X-ray infiltrate Severe CAP CRP >150 mg/L | Rate of treatment failure: Early (<72 h) Late (72–120 h) | Achieved. 59 in the MP group vs. 1628 in the placebo group. Mean difference 1 9 (5–33), p = 0.01 Not achieved for early treatment failure: 35 in the MP group vs. 47 in the placebo group. Mean difference 2 (−7 to 11 ), p> 0.99 Achieved for late treatment failure 24 in the MP group vs. 1425 in the placebo group. Mean difference 21 (9–33), p = 0.002 |
Not significant differences in time to clinical stability, length of hospital stay, length of ICU stay, in-hospital mortality. | No significant differences |
| Blum et al 2015, Lancet17 | Double-blind, placebo-controlled, RCT 1:1 | PDN (50 mg qd for 7 d) vs. placebo | 802 | Adult CAP | Time to clinical stability (days) | Achieved. 3.0 (2.5–3.4) d in PDN group vs. 4.4 (4.0–5.0) d in placebo group. HR 1.33 (1.15–1.50), p <0.0001 |
Significant reduction in time to hospital discharge and duration of intravenous antibiotic treatment in the PDN group. No significant difference in recurrent pneumonia, re-admission to hospital, ICU admission, time to ICU admission, time in ICU, death from any cause, time to death, total duration of antibiotic therapy, CAP score at days 5 and 30. |
Hyperglycemia |
| Meijvis et al 2011, Lancet18 | Double-blind, placebo-controlled, RCT 1:1 | DXM (5 mg gd for 4 d) vs. placebo | 304 | Adult CAP | Length of hospital stay (d) | Achieved. 6.5 (5.0–9.0) d in DXM group vs. 7.5 (5.3–11.5) d in placebo group, p = 0.0480 |
No significant differences in in-hospital mortality, time to death, 30-d mortality, ICU admission, time to ICU admission, length of stay in ICU, empyema or pleural effusion, re-admission within 30 d. | Hyperglycemia |
| Fernández-Serrano et al, 2011, Crit Care19 | Double-blind, RCT | MP (200 mg bolus, then 20 mg g6h for 3 d, then 20 mg q 12h for 3 d, then 20 mg gd) vs. placebo | 56 | Adult Consolidation at chest X-ray P/F <300 | Need for MV at day 9 | Not achieved. 1/28 in MPN group vs. 5/28 in placebo group, p> 0.05 |
Significant reduction in time to resolution of morbidity and IL-6 decrease in the MP group. No significant difference in ICU admission, duration of ICU stay, early and late mortality, length of stay. |
No significant differences |
| Snijders et al 2010, Am J Respir Crit Care Med20 | Double-blind, placebo-controlled, RCT 1:1 | PDN (40 mg gd for 7 d) vs. placebo | 213 | Adult symptoms new consolidation on chest X-ray | Clinical cure at day 7 | Not achieved. 84 (80.8) in PDN group vs. 93 (85.3) in placebo group. OR 0.72 (0.35–1.49), p = 0.38 |
Significant increase in late failure in the PDN group. No significant differences in clinical cure at day 30, 30-d mortality, length of stay, time to clinical stability, and early failure. |
No significant differences |
| Mlkaml et al 2007, Lung21 | Open-label, RCT 1:1 | PDN (40 mg gd for 3 d) vs. no PDN | 31 | Adult CAP | Length of hospital stay (days) | Not achieved. 11.3 (5.5) d in PDN group vs. 15.5 (1 0.7) d in no steroid group, p = 0.1 82 |
Significant reduction in duration of IV antibiotic, time to normalization of temperature, respiratory rate, and CRP in the PDN group. No differences in time to normalization of SpO2 and pulse rate. |
No significant differences |
| Confalonieri et al 2005, Am J Resplr Crit Care Med22 | Double-blind, placebo-controlled, RCT 1:1 | HCS 200 mg bolus, then 240 mg qd at 10 mg/h for 7 d vs. placebo | 48 | Severe CAP | Improvement of P/F and MODS score at day 8 and development of delayed septic shock. | Achieved for P/F Improvement. 2087 in HCS group vs. 939 in placebo group, p = 0.0018 Achieved for delayed septic shock. 0 (0) in HCS group vs. 1052 in placebo group, p <0.001 Achieved for MODS score Improvement. 0.3 (0.5) in HCS group vs. 1.0 (0.9) in placebo group, p = 0.003 |
Significant reduction in ICU mortality, hospital mortality, 60-d mortality, length of ICU stay, length of hospital stay, and duration of mechanical ventilation in the HCS group. | Increased incidence of major complication in the placebo group |
Abbreviations: ARDS, acute respiratory distress syndrome; CAP, community-acquired pneumonia; CRP, C-reactive protein; CT, computed tomography; DXM, dexamethasone; HCS, hydrocortisone; HR, hazard ratio; ICU, intensive care unit; IL-6: interleukin-6; IMV, invasive mechanical ventilation; iv, intravenous; MODS, multiple organ dysfunction syndrome; MP, méthylprednisolone; MV, mechanical ventilation; NIMV, noninvasive mechanical ventilation; P/F: arterial oxygen partial pressure out of FiO2; PDN, prednisolone; q6h/q12h, every 6/12 h administration; qd: once a day; RCT, randomized controlled trial; SpO2, peripheral oxygen saturation; vs: versus.