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akinohanayuki日記

自分が興味あることを書いています. 主に感染領域. 二次利用は自己責任でお願いします. 博士(薬学). 感染制御専門薬剤師.

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.

www.ncbi.nlm.nih.gov

2015年Lancetに報告された、スイス7施設による成人の市中肺炎に対するプレドニゾロンvsプラセボのRCT.

 

 

 

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

 

limitations 

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. 
f:id:akinohanayuki:20170516055552p:plain f:id:akinohanayuki:20170516055605p:plain f:id:akinohanayuki:20170516055648p:plainf:id:akinohanayuki:20170516055617p:plainf:id:akinohanayuki:20170516055655p:plain 
 

感想

 
主アウトカムは、綺麗に効果を示ました。市中肺炎と心不全の鑑別が決まれば、ステロイドも考慮できそうな結果ですね。
副次アウトカムは、イマイチな結果ですね、参考程度ですが。再燃、再入院、ICU期間に差がないことは、寂しいです。