Steroid Therapy and Outcome of Parapneumonic Pleural Effusions (STOPPE): A Pilot Randomized Clinical Trial

Fitzgerald DB et al.

Am J Respir Crit Care Med Volume 205, Issue 9, May 2022, Pages 1093-1101

What is the Key Question?

  • Does corticosteroid therapy improve outcomes in adult patients with pneumonia-related pleural effusion?

What is the Bottom Line?

  • This is a pilot, multicenter, double-blinded, placebo-controlled, randomized trial involving six Australian centers where patients with community-acquired pneumonia and pleural effusion were randomized (2:1) to intravenous dexamethasone (4 mg twice daily for 48 hours, n=51) or placebo (n=28) and followed for 30 days.
  • The study found no preliminary evidence of benefits of dexamethasone in improving time to sustained (>12 hours) normalization of vital signs (temperature, oxygen saturations, blood pressure, heart, and respiratory rates). Similarly, there were no differences in markers of inflammation (C-reactive protein or leukocyte counts).
  • The need for pleural drainage procedures was not significantly different (P=0.60) in both groups (49.0% of dexamethasone-treated and 42.9% of placebo-treated patients). Other factors such as the mean duration of antibiotic therapy and median hospitalization were similar between the dexamethasone and placebo groups.
  • Serious adverse events occurred in 25.5% of dexamethasone-treated and 21.4% of placebo-treated patients. Transient hyperglycemia more commonly affected the dexamethasone group (15.6% vs. 7.1%).

Why read on?

  • This pilot study showed that systemic corticosteroids has no preliminary benefits in adults with parapneumonic effusions.