This article is more than 5 years old. Information may no longer be current.
Steroids decrease treatment failure in severe pneumonia
Click Here to Manage Email Alerts
The use of methylprednisolone was related to decreased treatment failure among patients with severe community-acquired pneumonia and a high initial inflammatory response, researchers from Spain have found.
“The results demonstrated that the acute administration of methylprednisolone was associated with less treatment failure and a lower inflammatory response in a prospectively identified population with both severe community-acquired pneumonia and a high inflammatory response,” the researchers wrote in JAMA. “If replicated, these findings would support the use of corticosteroids as adjunctive treatment in this clinical population.”
Antoni Torres, MD, PhD, of the Servei de Pneumologia, Institut Clínic del Torax, Hospital Clínic in Barcelona, and colleagues, conducted the trial in three hospitals. Patients with severe community-acquired pneumonia and a high inflammatory response (C-reactive protein > 150 mg/L) were randomly assigned an IV bolus of methylprednisolone (n = 61) or placebo (n = 59) for 5 days. All patients received antibiotics according to international guidelines during the study from June 2004 to February 2012.
Ninety-three percent of patients completed the study, and those assigned methylprednisolone experienced less treatment failure compared with patients assigned placebo (13% vs. 31%; P = .02). The results were similar in the per-protocol population. In adjusted analyses, methylprednisolone decreased the risk for treatment failure in the intention-to-treat population (aOR = 0.33; 95% CI, 0.12-0.9) and in the per-protocol population (aOR = 0.26; 95% CI, 0.08-0.79). There was no difference in in-hospital mortality, length of hospital or ICU stay or adverse events.
“Severe community-acquired pneumonia remains a major cause of mortality, and despite effective antibiotic therapy, 12% to 36% of patients admitted to the ICU die within a short period,” the researchers wrote. “In addition, patients in risk class V for the Pneumonia Severity Index also have a high mortality risk. Therefore, the development of an efficacious adjunctive treatment has important implications for reducing this high rate of mortality.”
In an accompanying editorial, Richard G. Wunderink, MD, of Northwestern University Feinberg School of Medicine, wrote that corticosteroids are not for every patient, and that it is necessary to determine exactly what the steroids are preventing.
“Because radiographic progression during the period between 72 hours and 5 days was the primary driver of treatment differences, understanding what this clinical finding represents is key to acceptance of the findings,” Wunderink wrote. “A larger definitive study is needed to confirm that less radiographic progression does in fact lead to lower mortality.”
Disclosure: Torres reports no relevant financial disclosures. Please see the full study for a list of all other authors’ relevant financial disclosures. Wunderink reports no relevant financial disclosures.
Click Here to Manage Email Alerts