TY - JOUR T1 - Adjunctive treatment with oral dexamethasone in non-ICU patients hospitalised with community-acquired pneumonia: a randomised clinical trial JF - European Respiratory Journal JO - Eur Respir J DO - 10.1183/13993003.02535-2020 VL - 58 IS - 2 SP - 2002535 AU - Esther Wittermans AU - Stefan M.T. Vestjens AU - Simone M.C. Spoorenberg AU - Willem L. Blok AU - Jan C. Grutters AU - Rob Janssen AU - Ger T. Rijkers AU - Frank W.J.M. Smeenk AU - G. Paul Voorn AU - Ewoudt M.W. van de Garde AU - Willem Jan W. Bos AU - the Santeon-CAP Study Group Y1 - 2021/08/01 UR - http://erj.ersjournals.com/content/58/2/2002535.abstract 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.Adjunctive treatment with oral dexamethasone in adults hospitalised with community-acquired pneumonia (CAP) reduced length of stay and ICU admission rate. However, it remains unclear for which CAP subgroup the risk–benefit ratio is optimal. https://bit.ly/35tXfPX ER -