TOPLINE:

Adding glucocorticoids to standard care within 48 hours of hospital admission reduced the risk for death in patients with community-acquired pneumonia (CAP) in low-resource settings and was safe as an add-on to conventional therapy.

METHODOLOGY:

• Researchers conducted a pragmatic randomized controlled trial to evaluate the efficacy and safety of adjunctive low-dose glucocorticoids in CAP in low-resource settings.
• Eligible patients were required to be diagnosed with CAP within 48 hours of admission, with CAP defined as the presence of two or more symptoms such as cough, fever, dyspnea, hemoptysis, chest pain, or crackles on chest examination for less than 14 days.
• They enrolled 2180 patients (median age, 53 years; 46.3% female) who were randomly assigned to receive either standard care plus glucocorticoids (n = 1089) or standard care alone (n = 1091) across 18 public hospitals in Kenya.
• The primary outcome was all-cause mortality within 30 days post-enrollment, and secondary outcomes were death at days 7, 14, and 21, both during hospitalization and after discharge.

TAKEAWAY:

• Patients receiving standard care plus glucocorticoids had a lower 30-day mortality rate than those receiving standard care alone (hazard ratio [HR] for death, 0.84; 95% CI, 0.73-0.97).
• Rates of in-hospital mortality (18.0% vs 20.4%) and postdischarge mortality (4.6% vs 5.6%) were also slightly lower in the standard care plus glucocorticoid group than in the standard care group.
• A total of 0.5% of serious adverse events were potentially related to glucocorticoid administration.

IN PRACTICE:

“In our trial involving patients who were hospitalized with CAP in a low-resource setting, the adjunctive use of glucocorticoids was associated with a lower risk of death from any cause than standard care,” the authors of the study wrote.

“For clinicians, it offers hope that glucocorticoids, an inexpensive, accessible intervention, can save the lives of African patients with pneumonia. For policymakers, it highlights the necessity of ensuring safe, equitable implementation,” the authors of a linked editorial wrote.

SOURCE:

The study was led by Ruth K. Lucinde, MMed, Kenya Medical Research Institute-Wellcome Trust Research Program, Kilifi, Kenya. It was published online on October 29, 2025, in The New England Journal of Medicine.

LIMITATIONS:

The main limitation was the enrollment of a heterogeneous patient group because of limited diagnostic and treatment resources. Broad eligibility that did not consider pneumonia severity and prognostic factors at baseline may have biased the results toward the null. Additionally, the open-label design, unavailability of data on time to steroid initiation, and use of oral rather than intravenous formulations may have affected outcomes and limited the study’s generalizability.

DISCLOSURES:

The study was supported by grants from the Wellcome Trust; the UK Foreign, Commonwealth & Development Office; and the Bill & Melinda Gates Foundation, with additional support from the Science for Africa Foundation. Two authors disclosed receiving grants or contracts from Gilead Sciences, ViiV Healthcare, the National Institute for Health Research, and the Wellcome Trust, as well as having other financial ties with GlaxoSmithKline and Merck Sharp & Dohme Corporation.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.