akinohanayuki ブログ

学位を持っても、センスのない、感染制御専門薬剤師のブログ.  I have Ph.D. but less sense ID pharmacist.

Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial.

Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial.






P : patients aged 18 years or older with community-acquired pneumonia

E : prednisone 50 mg daily for 7 days 

C : placebo

O : 

Median time to clinical stability was shorter in the prednisone group (3·0 days, IQR 2·5-3·4) than in the placebo group (4·4 days, 4·0-5·0; hazard ratio [HR] 1·33, 95% CI 1·15-1·50, p<0·0001). 

Pneumonia-associated complications until day 30 did not differ between groups (11 [3%] in the prednisone group and 22 [6%] in the placebo group; odds ratio [OR] 0·49 [95% CI 0·23-1·02]; p=0·056).

The prednisone group had a higher incidence of in-hospital hyperglycaemia needing insulin treatment (76 [19%] vs 43 [11%]; OR 1·96, 95% CI 1·31-2·93, p=0·0010).

T : double-blind, multicentre, randomised, placebo-controlled trial



First, we exclusively included patients admitted to hospital, which precludes a generalisation to patients in ambulatory care. Second, our study was not powered for mortality; therefore, mortality data have to be acknowledged with care. Third, our primary endpoint, time to clinical stability, has limitations, since it is a combined endpoint including several parameters; however, it is a well accepted and frequently used endpoint in patients with community-acquired pneumonia. Finally, corticosteroid-induced hyperglycaemia might have led to unblinding in some patients. 
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