Glucocorticoids Reduce Death Risk in Pneumonia Patients in Low-Resource Settings: NEJM
Researchers have established that the addition of oral low-dose glucocorticoids to the standard management significantly reduces mortality among patients with community-acquired pneumonia in low-resource settings. The study concluded that patients receiving adjunctive glucocorticoid therapy had a lower 30-day death rate compared to those receiving standard care alone. The study was published in The New England Journal of Medicine by Ruth K. and colleagues.
Community-acquired pneumonia remains one of the leading causes of illness and death worldwide, particularly in low- and middle-income countries where access to advanced care is limited. In high-income countries, adjunctive glucocorticoids have been associated with a potential benefit in inflammation reduction and better survival in severe CAP. However, their effectiveness and safety in low-resource settings had, until recently, remained uncertain.
This study is a pragmatic, open-label, randomized controlled trial conducted across 18 public hospitals in Kenya. Between admission and the initiation of therapy, there were 2,180 adult patients diagnosed with CAP enrolled. Patients without clear contraindications to glucocorticoids were randomised in a 1:1 fashion to either standard care alone (1091) or oral low-dose glucocorticoids for 10 days alongside standard care (1089). The primary outcome was death from any cause within 30 days after enrolment. Adverse and serious adverse events were also monitored throughout the study period to assess the safety of glucocorticoid use in this population.
Results
• Among the 2,180 participants, the median age was 53 years (interquartile range, 38–72), and 46% were women.
• At 30 days, 530 patients (24.3%) had died, 246 (22.6%) in the glucocorticoid group and 284 (26.0%) in the standard-care group. This represented a hazard ratio (HR) of 0.84 (95% CI, 0.73–0.97; P=0.02), indicating a 16% relative reduction in mortality risk among those who received glucocorticoids.
• The frequencies of adverse events and serious adverse events were comparable between the two groups.
• Serious adverse events related to glucocorticoid use were rare, occurring in only 5 patients (0.5%).
This large pragmatic trial conducted in Kenyan public hospitals showed that low-dose glucocorticoid therapy as an adjunct to usual care reduced 30-day mortality among patients with community-acquired pneumonia. The treatment was safe, feasible, and effective, even in resource-limited healthcare environments.
Reference:
Lucinde, R. K., Gathuri, H., Mwaniki, P., Orindi, B., Otieno, E. O., Mwakio, S., Mulemi, L., Isaaka, L., Shangala, J., Saisi, M., Isinde, E., Oginga, I. N., Wachira, A. W., Manuthu, E., Kariuki, H., Asaava, P., Nyikuli, J., Wekesa, C., Otedo, A., … Etyang, A. O. (2025). A pragmatic trial of glucocorticoids for community-acquired pneumonia. The New England Journal of Medicine, NEJMoa2507100. https://doi.org/10.1056/NEJMoa2507100
