Late Breaking Abstract - Adjunctive Treatment With Oral Dexamethasone In Adults Hospitalised With Community-Acquired Pneumonia: A Randomised Clinical Trial

Background: Adjunctive intravenous corticosteroid treatment has shown to reduce length of stay (LOS) in adults hospitalised with community-acquired pneumonia (CAP). However, the effect of oral dexamethasone on LOS and whether this effect is disease severity dependent remains unclear. Aims & objectives: 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, 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)) than in the placebo group (5.0 days (95% CI 4.6-5.4); p=0.03). Within both CAP severity subgroups, differences in LOS between treatment groups were not statistically significant. Secondary ICU admission rate was lower in the dexamethasone arm (5(3%) vs 14(7%), p=0.03), 30-day mortality did not differ between groups. In the dexamethasone group rate of hospital readmission tended to be higher (19(10%) vs 9(5%); p=0.07) and hyperglycaemia (14(7%) vs 1 (1%);p=0.001) was more prevalent. Conclusion Oral dexamethasone reduced LOS and ICU admission rate in adults with CAP. It remains unclear for which patients the risk-benefit ratio is optimal.