Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: A randomised clinical trial (2024)

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.

Original languageEnglish
Article number2002535
Pages (from-to)1-10
JournalEuropean Clinical Respiratory Journal
Volume58
Issue number2
Early online date14 Jan 2021
DOIs
Publication statusPublished - 1 Aug 2021

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    Wittermans, E., Vestjens, S. M., Spoorenberg, S. M., Blok, W. L., Grutters, J. C., Janssen, R., Rijkers, G. T., Smeenk, F. W., Voorn, P., van de Garde, E. M., & Bos, W. J. W. (2021). Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: A randomised clinical trial. European Clinical Respiratory Journal, 58(2), 1-10. Article 2002535. https://doi.org/10.1183/13993003.02535-2020

    Wittermans, Esther ; Vestjens, Stefan Mt ; Spoorenberg, Simone Mc et al. / Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia : A randomised clinical trial. In: European Clinical Respiratory Journal. 2021 ; Vol. 58, No. 2. pp. 1-10.

    @article{c6a324ad2e5d4f7fa89b269dd6e1889e,

    title = "Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: A randomised clinical trial",

    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.",

    author = "Esther Wittermans and Vestjens, {Stefan Mt} and Spoorenberg, {Simone Mc} and Blok, {Willem L} and Grutters, {Jan C} and Rob Janssen and Rijkers, {Ger T} and Smeenk, {Frank Wjm} and Paul Voorn and {van de Garde}, {Ewoudt Mw} and Bos, {Willem Jan W}",

    note = "Funding Information: Conflict of interest: E. Wittermans has nothing to disclose. S.M.T. Vestjens has nothing to disclose. S.M.C. Spoorenberg has nothing to disclose. W.L. Blok has nothing to disclose. J.C. Grutters has nothing to disclose. R. Janssen has nothing to disclose. G.T. Rijkers has nothing to disclose. F.W.J.M. Smeenk has nothing to disclose. G.P. Voorn has nothing to disclose. E.M.W. van de Garde has nothing to disclose. W.J.W. Bos reports grants from Zilveren Kruis Insurance, outside the submitted work. Publisher Copyright: Copyright {\textcopyright} The authors 2021.",

    year = "2021",

    month = aug,

    day = "1",

    doi = "10.1183/13993003.02535-2020",

    language = "English",

    volume = "58",

    pages = "1--10",

    journal = "European Clinical Respiratory Journal",

    issn = "0903-1936",

    publisher = "European Respiratory Society",

    number = "2",

    }

    Wittermans, E, Vestjens, SM, Spoorenberg, SM, Blok, WL, Grutters, JC, Janssen, R, Rijkers, GT, Smeenk, FW, Voorn, P, van de Garde, EM & Bos, WJW 2021, 'Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: A randomised clinical trial', European Clinical Respiratory Journal, vol. 58, no. 2, 2002535, pp. 1-10. https://doi.org/10.1183/13993003.02535-2020

    Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: A randomised clinical trial. / Wittermans, Esther; Vestjens, Stefan Mt; Spoorenberg, Simone Mc et al.
    In: European Clinical Respiratory Journal, Vol. 58, No. 2, 2002535, 01.08.2021, p. 1-10.

    Research output: Contribution to journalArticleAcademicpeer-review

    TY - JOUR

    T1 - Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia

    T2 - A randomised clinical trial

    AU - Wittermans, Esther

    AU - Vestjens, Stefan Mt

    AU - Spoorenberg, Simone Mc

    AU - Blok, Willem L

    AU - Grutters, Jan C

    AU - Janssen, Rob

    AU - Rijkers, Ger T

    AU - Smeenk, Frank Wjm

    AU - Voorn, Paul

    AU - van de Garde, Ewoudt Mw

    AU - Bos, Willem Jan W

    N1 - Funding Information:Conflict of interest: E. Wittermans has nothing to disclose. S.M.T. Vestjens has nothing to disclose. S.M.C. Spoorenberg has nothing to disclose. W.L. Blok has nothing to disclose. J.C. Grutters has nothing to disclose. R. Janssen has nothing to disclose. G.T. Rijkers has nothing to disclose. F.W.J.M. Smeenk has nothing to disclose. G.P. Voorn has nothing to disclose. E.M.W. van de Garde has nothing to disclose. W.J.W. Bos reports grants from Zilveren Kruis Insurance, outside the submitted work.Publisher Copyright:Copyright © The authors 2021.

    PY - 2021/8/1

    Y1 - 2021/8/1

    N2 - 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.

    AB - 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.

    UR - http://www.scopus.com/inward/record.url?scp=85112844392&partnerID=8YFLogxK

    U2 - 10.1183/13993003.02535-2020

    DO - 10.1183/13993003.02535-2020

    M3 - Article

    C2 - 33446608

    SN - 0903-1936

    VL - 58

    SP - 1

    EP - 10

    JO - European Clinical Respiratory Journal

    JF - European Clinical Respiratory Journal

    IS - 2

    M1 - 2002535

    ER -

    Wittermans E, Vestjens SM, Spoorenberg SM, Blok WL, Grutters JC, Janssen R et al. Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: A randomised clinical trial. European Clinical Respiratory Journal. 2021 Aug 1;58(2):1-10. 2002535. Epub 2021 Jan 14. doi: 10.1183/13993003.02535-2020

    Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: A randomised clinical trial (2024)
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