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

Esther Wittermans; Stefan Mt Vestjens; Simone Mc Spoorenberg; Willem L Blok; Jan C Grutters; Rob Janssen; Ger T Rijkers; Frank Wjm Smeenk; Paul Voorn; Ewoudt Mw van de Garde; Willem Jan W Bos

doi:10.1183/13993003.02535-2020

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

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

Department of Internal Medicine, St. Antonius Hospital, Nieuwegein, the Netherlands [email protected].
Department of Internal Medicine, St Antonius Hospital, Nieuwegein, the Netherlands.
Department of Internal Medicine, OLVG, Amsterdam, The Netherlands.
University Medical Center Utrecht
Department of Pulmonology, Canisius Wilhelmina Hospital, Nijmegen, the Netherlands.
Department of Pulmonology, Catharina Hospital, Eindhoven, the Netherlands.
Department of Medical Microbiology and Immunology, St. Antonius Hospital, Nieuwegein, the Netherlands.
Department of Internal Medicine - division Nephrology, Leiden University Medical Centre, Leiden, the Netherlands.

Research output: Contribution to journal › Article › Academic › peer-review

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 language	English
Article number	2002535
Pages (from-to)	1-10
Journal	European Clinical Respiratory Journal
Volume	58
Issue number	2
Early online date	14 Jan 2021
DOIs	https://doi.org/10.1183/13993003.02535-2020
Publication status	Published - 1 Aug 2021

Bibliographical 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 © The authors 2021.

Access to Document

10.1183/13993003.02535-2020

2002535.fullFinal published version, 558 KBLicence: Taverne

Cite this

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

@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 journal › Article › Academic › peer-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 -

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

Abstract

Bibliographical note

Access to Document

Other files and links

Fingerprint

Cite this