The benefits or harms of systemic corticosteroids for community-acquired pneumonia in adults: аn overview of reviews

Abstract

Background: The problem of reducing mortality in patients with community-acquired pneumonia remains extremely important despite the progress in the development of antibiotics. There is a certain consensus on the etiological treatment of typical and atypical variants of the disease, however, the efficacy of corticosteroids as a means of pathogenetic therapy for many years has remained a subject of discussion, in spite of the large number of studies conducted and several dozen reviews of them. The aim of our study is to summarize more than one systematic review of randomized controlled trials to assess the evidence for the effect of adjuvant systemic CS in adults with CAP on mortality, symptom dynamics, risk of complications, and harmful side effects. Methods: From July to September 2020, we searched for systematic reviews in the PubMed, Embase, CENTRAL databases in accordance with the recommendations of the Cochrane Guidelines for Systematic Reviews 6 version up to 2020. The methodological level of the selected reviews was assessed using the АMSTAR-2 form. Results: 12 systematic reviews were selected that were performed in different countries from 2012 to 2018, covering 24 clinical trials with 2,791 participants. Comparison and generalization of review data confirms that additional prescription of CS led to a decrease in mortality in severe CAP, and with any severity of CAP - to a decrease in the risk of treatment failure in the first 57 days from its onset, acceleration of the onset of signs of clinical improvement, and a decrease in the risk of development respiratory failure and transfer to artificial lung ventilation, reducing the length of hospital stay and treatment in the intensive care unit. Short courses of steroid therapy did not increase the risk of harmful plug events, with the exception of hyperglycemia, which was easily controlled. Our analysis has also shown that there is a feasibility of bridging the gap between existing regulations and the evidence base for current systematic reviews of RCTs on the use of CS in CAP.