CLINICAL QUESTION: Do glucocorticoids reduce mortality in hospitalized adults with community-acquired pneumonia in a resource-limited setting?
BACKGROUND: The use of glucocorticoids as adjunctive therapy in community-acquired pneumonia (CAP) has shown benefits in some trials conducted in high-income countries; however, their effects in resource-limited settings with a high burden of comorbidities are not well established.
STUDY DESIGN: Pragmatic, open-label, randomized controlled trial (the SONIA trial)
SETTING: 18 public hospitals in Kenya
SYNOPSIS: This randomized clinical trial enrolled 2,180 adults hospitalized with CAP across 18 public hospitals in Kenya and assigned them to receive either standard care or standard care plus low-dose oral glucocorticoids for 10 days, initiated within 48 hours after hospital admission. The median age was 53 years (interquartile range, 38 to 72 years), and 46% were women. At day 30, mortality was 22.6% in the glucocorticoid group compared with 26% in the standard care group (HR, 0.84; 95% CI, 0.73 to 0.97; P=0.021). There were no significant differences in total or serious adverse events between groups, and only 0.4% of patients experienced serious adverse events attributable to glucocorticoids. This trial provides evidence of clinical benefit from glucocorticoids in CAP outside the intensive care unit in a resource-limited setting, although heterogeneity in standard treatment and the lack of specific etiologic diagnosis should be considered.
BOTTOM LINE: The addition of low-dose glucocorticoids to standard care for community-acquired pneumonia reduced 30-day mortality in a resource-limited setting.
CITATION: Lucinde RK, et al. A pragmatic trial of glucocorticoids for community-acquired pneumonia. N Engl J Med. 2025;393(22):2187-2197. doi: 10.1056/NEJMoa2507100.
Dr. de la Puente is a hospitalist in the department of clinical medicine at Hospital Aleman and an instructor of internal medicine at the University of Salvador, both in Buenos Aires, Argentina.