ADJUNCTIVE glucocorticoid therapy has shown promise in reducing mortality among patients with severe community-acquired pneumonia (CAP) in well-resourced settings. However, evidence for its effectiveness in low-resource environments has been limited. A new pragmatic, open-label, randomized trial conducted across 18 hospitals in Kenya sought to address this knowledge gap by testing whether adding oral low-dose glucocorticoids to standard CAP treatment could improve survival.
Study Design and Participants
The trial enrolled 2,180 adult patients diagnosed with CAP who did not have a clear clinical indication for glucocorticoids. Patients were randomized to receive either standard care alone or standard care plus oral glucocorticoids for 10 days. Participants ranged in age from 38 to 72 years (median 53 years), with women comprising 46% of the cohort. The pragmatic design reflected real-world conditions, including limited diagnostic facilities and variability in supportive care, making the results highly relevant to low-resource settings.
Mortality Reduction with Glucocorticoids
At 30 days post-enrollment, a total of 530 deaths (24.3%) were recorded. Mortality was lower in the glucocorticoid group, with 246 deaths (22.6%), compared to 284 deaths (26.0%) in the standard-care group. This corresponds to a hazard ratio of 0.84 (95% CI, 0.73–0.97; P=0.02), demonstrating a statistically significant survival benefit for patients receiving adjunctive glucocorticoids.
The frequency of adverse events and serious adverse events was comparable between groups. Only five patients (0.5%) experienced serious events considered related to glucocorticoid use, suggesting that this therapy is well-tolerated, even in settings with limited resources.
Clinical Implications
These findings support the integration of community-acquired pneumonia glucocorticoids into standard CAP management, particularly in low-resource hospitals where advanced supportive care is limited. By reducing 30-day mortality without adding significant safety risks, adjunctive glucocorticoids offer a practical, life-saving intervention. This trial provides robust evidence for healthcare providers to consider glucocorticoids as part of routine CAP treatment, potentially improving outcomes for thousands of patients in similar healthcare settings worldwide.
Reference
Lucinde RK et al. A Pragmatic Trial of Glucocorticoids for Community-Acquired Pneumonia. N Engl J Med. 2025; DOI: 10.1056/NEJMoa2507100.
