Articles<\/p>\n\n\n\n
Pneumocystis jirovecii<\/a> pneumonia in HIV-negative immunocompromised patients<\/a> has a hospital mortality rate of 30\u201350%. Adjunctive corticosteroids improve outcomes of P jirovecii<\/em> pneumonia in HIV-positive patients. The aim of this trial was to assess the effects of early adjunctive corticosteroid therapy<\/a> for 21 days in HIV-negative patients with P jirovecii<\/em> pneumonia responsible for acute hypoxaemia<\/a> respiratory failure.<\/p>\n\n\n\n This multicentre, double-blind,\u00a0randomised controlled trial<\/a>\u00a0was conducted at 27 hospitals in France. We included patients with\u00a0acute respiratory failure<\/a>, aged 18 years or older with mild-to-severe\u00a0hypoxaemia<\/a>, microbiological documentation of\u00a0P jirovecii<\/em>pneumonia, and anti-Pneumocystis<\/em>\u00a0treatment duration of less than 7 days. Patients were randomly assigned (1:1) to the corticosteroid group (adjunctive\u00a0corticosteroid therapy<\/a>\u00a0of\u00a0methylprednisolone<\/a>\u00a0intravenously, 30 mg twice per day from days 1 to 5, 30 mg once per day from days 6 to 10, and 20 mg once per day until day 21) or placebo group (2 mL or 3 mL syringes of isotonic saline intravenously) using a web-based system. Permutation blocks of fixed size unknown to the local investigators were used. Stratification factors were centre, long-term corticosteroid treatment started more than 1 month before enrolling in the trial, underlying disease (malignancy\u00a0vs<\/em>\u00a0other), and oxygen needs at randomisation (<6\u00a0vs<\/em>\u00a0\u22656 L per min). The primary outcome was all-cause 28-day mortality defined as the proportion of patients who died within 28 days, analysed in the intention-to-treat (ITT) population. This trial was registered on\u00a0ClinicalTrials.gov<\/a>,\u00a0NCT02944045<\/a>(closed).<\/p>\n\n\n\nMethods<\/h3>\n\n\n\n
Findings<\/h3>\n\n\n\n