Prednisone for community-acquired pneumonia: not yet time

摘要

We applaud Claudine Blum and colleagues (April 18, p 1511)1 for their study on adjunct prednisone therapy for patients with community-acquired pneumonia. However, we have reservations about the interpretation of the study in the accompanying Comment,2 which suggests that it is time to change clinical practice. First, the primary endpoint is not a clinical event (eg, mortality) but a composite of physiological measurements, some of which are affected favourably by high-dose glucocorticoids (eg, fever and hypotension). Therefore, achievement of a clinically stable status by this all-or-nothing strategy (in meeting these physiological criteria), gives the treatment group an unfair advantage.3 To further prove this point, if (con versely) euglycaemia was a criterion for achievement of clinical stability, the treatment group would be unfairly disadvantaged.