Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: a randomised clinical trial
Esther Wittermans, Stefan M T Vestjens, Simone M C Spoorenberg, Willem L Blok, Jan C Grutters, Rob Janssen, Ger T Rijkers, Frank W J M Smeenk, G Paul Voorn, Ewoudt M W van de Garde, Willem Jan W Bos, Santeon-CAP Study Group, Members of the Santeon-CAP Study Group, Willem Jan W Bos, Ewoudt M W van de Garde, Jan C Grutters, Ger T Rijkers, Douwe H Biesma, G Paul Voorn, Simone M C Spoorenberg, Stefan M T Vestjens, Esther Wittermans, Frank W J M Smeenk, Arnoud F Aldenkamp, Rob Janssen, Charlotte A van Ruitenbeek, Willem L Blok, Paul Bresser, Joris W T van Enschot, Hester A A Zegers, Esther Wittermans, Stefan M T Vestjens, Simone M C Spoorenberg, Willem L Blok, Jan C Grutters, Rob Janssen, Ger T Rijkers, Frank W J M Smeenk, G Paul Voorn, Ewoudt M W van de Garde, Willem Jan W Bos, Santeon-CAP Study Group, Members of the Santeon-CAP Study Group, Willem Jan W Bos, Ewoudt M W van de Garde, Jan C Grutters, Ger T Rijkers, Douwe H Biesma, G Paul Voorn, Simone M C Spoorenberg, Stefan M T Vestjens, Esther Wittermans, Frank W J M Smeenk, Arnoud F Aldenkamp, Rob Janssen, Charlotte A van Ruitenbeek, Willem L Blok, Paul Bresser, Joris W T van Enschot, Hester A A Zegers
Abstract
Background: Adjunctive intravenous corticosteroid treatment has been shown to reduce length of stay (LOS) in adults hospitalised with community-acquired pneumonia (CAP). We aimed to assess the effect of oral dexamethasone on LOS and whether this effect is disease severity dependent.
Methods: In this multicentre, stratified randomised, double-blind, placebo-controlled trial, immunocompetent adults with CAP were randomly assigned (1:1 ratio) to receive oral dexamethasone (6 mg once daily) or placebo for 4 days in four teaching hospitals in the Netherlands. Randomisation (blocks of four) was stratified by CAP severity (pneumonia severity index class I-III and IV-V). The primary outcome was LOS.
Results: Between December 2012 and November 2018, 401 patients were randomised to receive dexamethasone (n=203) or placebo (n=198). Median LOS was shorter in the dexamethasone group (4.5 days, 95% CI 4.0-5.0 days) than in the placebo group (5.0 days, 95% CI 4.6-5.4 days; p=0.033). Within both CAP severity subgroups, differences in LOS between treatment groups were not statistically significant. The secondary ICU admission rate was lower in the dexamethasone arm (5 (3%) versus 14 (7%); p=0.030); 30-day mortality did not differ between groups. In the dexamethasone group the rate of hospital readmission tended to be higher (20 (10%) versus 9 (5%); p=0.051) and hyperglycaemia (14 (7%) versus 1 (1%); p=0.001) was more prevalent.
Conclusion: Oral dexamethasone reduced LOS and ICU admission rate in adults hospitalised with CAP. It remains unclear for which patients the risk-benefit ratio is optimal.
Trial registration: ClinicalTrials.gov NCT01743755.
Conflict of interest statement
Conflict of interest: E. Wittermans has nothing to disclose. Conflict of interest: S.M.T. Vestjens has nothing to disclose. Conflict of interest: S.M.C. Spoorenberg has nothing to disclose. Conflict of interest: W.L. Blok has nothing to disclose. Conflict of interest: J.C. Grutters has nothing to disclose. Conflict of interest: R. Janssen has nothing to disclose. Conflict of interest: G.T. Rijkers has nothing to disclose. Conflict of interest: F.W.J.M. Smeenk has nothing to disclose. Conflict of interest: G.P. Voorn has nothing to disclose. Conflict of interest: E.M.W. van de Garde has nothing to disclose. Conflict of interest: W.J.W. Bos reports grants from Zilveren Kruis Insurance, outside the submitted work.
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Source: PubMed