ESCAPe

Incomplete

Meduri G, et al. "Low-dose methylprednisolone treatment in critically ill patients with severe community-acquired pneumonia". Intensive Care Medicine. 2022. 48(8):1009-1023.
PubMed • Full text

Clinical Question

In patients with community acquired pneumonia, does low dose methylprednisolone reduce mortality in patients with severe community acquired pneumonia?

Bottom Line

Low dose methylprednisolone was not effective at reducing mortality at 60 days compared to placebo.

Major Points

The use have corticosteroids in community-acquired pneumonia remains a controversial topic. Although systematic reviews and meta-analyses have previously shown a mortality benefit in using corticosteroids for community-acquired pneumonia, the IDSA/ATS guidelines do not recommend the routine use of corticosteroids except in refractory shock. Some of the concerns arose from the heterogeneity in the included trials, included variable definitions of disease severity, dose, and molecule used.

The 2022 ESCAPe trial sought to answer whether corticosteroids were effective at reducing all-cause mortality among persons admitted with community acquired pneumonia. It enrolled 586 Veterans from 42 VA hospitals and randomized them to methylprednisolone 40 mg IV for 7 days with subsequent taper or placebo. There was no difference in 60-day mortality between groups (16% vs. 18%; aOR 0.90, 95% CI 0.57-1.40). This trial did not meet its target target recruitment of 1420 participants. Of note, the 2023 CAPE COD trial found benefit from hydrocortisone in a trial of 800 participants.

Design

• Multicenter, double-blind, parallel-group, randomized, controlled trial
• N=586
  • Methylprednisolone (n=)
  • Placebo (n=)
• Setting:
• Enrollment:
• Mean follow-up:
• Analysis:
• Primary outcome:

Outcomes

Comparisons are methylprednisolone vs. placebo.