title: Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomised, placebo-controlled trial.
abstract: BACKGROUND
  Clinical trials yielded conflicting data about the benefit of adding systemic corticosteroids for treatment of community-acquired pneumonia. We assessed whether short-term corticosteroid treatment reduces time to clinical stability in patients admitted to hospital for community-acquired pneumonia.
  
  
  METHODS
  In this double-blind, multicentre, randomised, placebo-controlled trial, we recruited patients aged 18 years or older with community-acquired pneumonia from seven tertiary care hospitals in Switzerland within 24 h of presentation. Patients were randomly assigned (1:1 ratio) to receive either prednisone 50 mg daily for 7 days or placebo. The computer-generated randomisation was done with variable block sizes of four to six and stratified by study centre. The primary endpoint was time to clinical stability defined as time (days) until stable vital signs for at least 24 h, and analysed by intention to treat. This trial is registered with ClinicalTrials.gov, number NCT00973154.
  
  
  RESULTS
  From Dec 1, 2009, to May 21, 2014, of 2911 patients assessed for eligibility, 785 patients were randomly assigned to either the prednisone group (n=392) or the placebo group (n=393). 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). Other adverse events compatible with corticosteroid use were rare and similar in both groups.
  
  
  CONCLUSIONS
  Prednisone treatment for 7 days in patients with community-acquired pneumonia admitted to hospital shortens time to clinical stability without an increase in complications. This finding is relevant from a patient perspective and an important determinant of hospital costs and efficiency.
  
  
  BACKGROUND
  Swiss National Science Foundation, Viollier AG, Nora van Meeuwen Haefliger Stiftung, Julia und Gottfried Bangerter-Rhyner Stiftung.
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Claudine Angela
authors.initials: CA
authors.lastname: Blum
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Nicole
authors.initials: N
authors.lastname: Nigro
authors.affiliation: Basel Institute for Clinical Epidemiology and Biostatistics, Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada.
authors.forename: Matthias
authors.initials: M
authors.lastname: Briel
authors.affiliation: Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Philipp
authors.initials: P
authors.lastname: Schuetz
authors.affiliation: Medical University Clinic, Kantonsspital Baselland/Liestal, Liestal, Switzerland.
authors.forename: Elke
authors.initials: E
authors.lastname: Ullmer
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Isabelle
authors.initials: I
authors.lastname: Suter-Widmer
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Bettina
authors.initials: B
authors.lastname: Winzeler
authors.affiliation: Emergency Department, University Hospital Basel, Basel, Switzerland.
authors.forename: Roland
authors.initials: R
authors.lastname: Bingisser
authors.affiliation: Medical University Clinic, Kantonsspital Baselland/Liestal, Liestal, Switzerland.
authors.forename: Hanno
authors.initials: H
authors.lastname: Elsaesser
authors.affiliation: Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Daniel
authors.initials: D
authors.lastname: Drozdov
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Birsen
authors.initials: B
authors.lastname: Arici
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Sandrine Andrea
authors.initials: SA
authors.lastname: Urwyler
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland.
authors.forename: Julie
authors.initials: J
authors.lastname: Refardt
authors.affiliation: Medical University Clinic, Kantonsspital Baselland/Bruderholz, Bruderholz, Switzerland.
authors.forename: Philip
authors.initials: P
authors.lastname: Tarr
authors.affiliation: Medical University Clinic, Kantonsspital Baselland/Bruderholz, Bruderholz, Switzerland.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Wirz
authors.affiliation: Department of Internal Medicine, Bürgerspital, Solothurn, Switzerland.
authors.forename: Robert
authors.initials: R
authors.lastname: Thomann
authors.affiliation: Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Christine
authors.initials: C
authors.lastname: Baumgartner
authors.affiliation: Clinic of Internal Medicine, Hôpital du Jura, Site de Delémont, Delémont, Switzerland.
authors.forename: Hervé
authors.initials: H
authors.lastname: Duplain
authors.affiliation: Viollier AG, Postfach, Basel, Switzerland.
authors.forename: Dieter
authors.initials: D
authors.lastname: Burki
authors.affiliation: Medical University Clinic, Kantonsspital Baselland/Liestal, Liestal, Switzerland.
authors.forename: Werner
authors.initials: W
authors.lastname: Zimmerli
authors.affiliation: Department of General Internal Medicine, Inselspital, Bern University Hospital, Bern, Switzerland.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Rodondi
authors.affiliation: Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland.
authors.forename: Beat
authors.initials: B
authors.lastname: Mueller
authors.affiliation: Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland. Electronic address: mirjam.christ@usb.ch.
authors.forename: Mirjam
authors.initials: M
authors.lastname: Christ-Crain
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D000900:Anti-Bacterial Agents / Q000627:therapeutic use; D000893:Anti-Inflammatory Agents / Q000008:administration & dosage*; D017714:Community-Acquired Infections / Q000188:drug therapy / Q000382:microbiology; D004311:Double-Blind Method; D004334:Drug Administration Schedule; D004359:Drug Therapy, Combination; D005260:Female; D006760:Hospitalization; D006801:Humans; D057194:Intention to Treat Analysis; D008297:Male; D008875:Middle Aged; D011014:Pneumonia / Q000188:drug therapy* / Q000382:microbiology; D011241:Prednisone / Q000008:administration & dosage*; D013557:Switzerland; D016896:Treatment Outcome
chemical_list: D000900:Anti-Bacterial Agents; D000893:Anti-Inflammatory Agents; D011241:Prednisone