Lucinde RK
Gathuri H
Mwaniki P
Orindi B
Otieno EO
Mwakio S
Mulemi L
Isaaka L
Shangala J
Saisi M
Isinde E
Oginga IN
Wachira AW
Manuthu E
Kariuki H
Asaava P
Nyikuli J
Wekesa C
Otedo A
Bosire H
Okoth SB
Ongalo W
Mukabi DM
Lusamba W
Muthui B
Adembesa I
Mithi C
Sood M
Aliyan NA
Gituma B
Matiko MG
Omondi CA
Ombajo LA
Kirui N
Ochola L
Abdi AI
Kagucia EW
English M
Hamaluba M
Ochola-Oyier I
Kamuya D
Bejon P
Barasa E
Agweyu A
Akech S
Etyang AO
N Engl J Med. 2025;3932187-2197
BACKGROUND: Adjunctive glucocorticoids may reduce mortality among patients with severe community-acquired pneumonia (CAP) in well-resourced settings. Whether these drugs are beneficial in low-resource settings with limited diagnostic and treatment facilities is unclear. METHODS: In this pragmatic, open-label, randomized, controlled trial conducted in 18 public hospitals in Kenya, we assigned adult patients who had received a diagnosis of CAP and who did not have a clear indication for glucocorticoids to receive either standard care for CAP or oral low-dose glucocorticoids for 10 days in addition to standard care. The primary outcome was death from any cause at 30 days after enrollment. RESULTS: A total of 2180 patients underwent randomization (1089 assigned to the glucocorticoid group and 1091 to the standard-care group). The median age of the patients was 53 years (interquartile range, 38 to 72); 46% were women. At day 30, deaths were reported in 530 patients (24.3%): 246 patients (22.6%) in the glucocorticoid group and 284 patients (26.0%) in the standard-care group (hazard ratio, 0.84; 95% confidence interval, 0.73 to 0.97; P = 0.02). The frequencies of adverse events and serious adverse events were similar in the two trial groups. Serious adverse events that were considered to be related to glucocorticoid administration occurred in 5 patients (0.5%). CONCLUSIONS: In patients with CAP in a low-resource setting, adjunctive glucocorticoid therapy was associated with a lower risk of death than standard care. (Funded by Wellcome Trust and others; SONIA PACTR number, PACTR202111481740832; ISRCTN number, ISRCTN36138594.).
