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Terapia complementaria con prednisona para pacientes con neumonía adquirida en la comunidad: un ensayo multicéntrico,

Claudine Angela Blum¹, Nicole Nigro², Matthias Briel³

¹Endocrinology, Diabetology and Metabolism, Department of Internal Medicine and Department of Clinical Research, University Hospital Basel, Basel, Switzerland; Medical University Clinic, Departments of Internal and Emergency Medicine and Department of Endocrinology, Diabetology and Clinical Nutrition, Kantonsspital Aarau, Aarau, Switzerland.

Lancet (London, England)

|January 23, 2015

Resumen

El tratamiento a corto plazo con prednisona acelera significativamente la recuperación de los pacientes hospitalizados con neumonía adquirida en la comunidad. Esta terapia con corticosteroides reduce el tiempo hasta la estabilidad clínica sin aumentar las complicaciones, mejorando los resultados de los pacientes y la eficiencia hospitalaria.

Área de la Ciencia:

Enfermedades infecciosas Enfermedades infecciosas.
Pulmonología Pulmonología.
Farmacología clínica Farmacología clínica.

Sus antecedentes:

Existen datos contradictorios de ensayos clínicos con respecto a la eficacia de los corticosteroides sistémicos para la neumonía adquirida en la comunidad (CAP).
Es crucial evaluar el impacto de la terapia con corticosteroides a corto plazo en el tiempo de recuperación en pacientes hospitalizados con CAP.

Objetivo del estudio:

Para determinar si el tratamiento corticosteroide a corto plazo acelera el tiempo hasta la estabilidad clínica en pacientes hospitalizados con neumonía adquirida en la comunidad.

Principales métodos:

Un ensayo doble ciego, multicéntrico, aleatorizado y controlado con placebo que involucró a 785 pacientes adultos con CAP.
Los pacientes recibieron prednisona 50 mg al día durante 7 días o un placebo.
Endpoint primario: tiempo hasta la estabilidad clínica (definido como signos vitales estables durante ≥24 horas), analizado por intención de tratar.

Principales resultados:

El tiempo medio para la estabilidad clínica fue significativamente más corto en el grupo de prednisona (3,0 días) en comparación con el grupo de placebo (4,4 días).
No hubo diferencias significativas en las complicaciones asociadas a la neumonía hasta el día 30 entre los grupos.
Mayor incidencia de hiperglucemia hospitalaria que requiere tratamiento con insulina en el grupo de prednisona (19% frente a 11%).

Conclusiones:

El tratamiento de siete días con prednisona para pacientes hospitalizados con neumonía adquirida en la comunidad acorta el tiempo hasta la estabilidad clínica.
Este enfoque terapéutico no aumenta las complicaciones y ofrece beneficios para la recuperación del paciente y la utilización de los recursos hospitalarios.

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