Influence of Prednisone on Inflammatory Biomarkers in Community-Acquired Pneumonia: Secondary Analysis of a Randomized Trial.

Abstract

Glucocorticoids are frequently prescribed in inflammatory diseases and have recently experienced a boom in the treatment of COVID-19. Small studies have shown an effect of glucocorticoids on inflammatory marker levels, but definitive proof is lacking. We investigated the influence of prednisone on inflammatory biomarkers in a previous multicenter, randomized, placebo-controlled trial that compared a 7-day treatment course of 50-mg prednisone to placebo in patients hospitalized with community-acquired pneumonia. We compared levels of C-reactive protein (CRP), procalcitonin (PCT), leukocyte and neutrophil count between patients with and without glucocorticoid treatment at baseline and on days 3, 5, and 7 and at discharge by Wilcoxon tests and analysis of variance. A total of 356 patient data sets in the prednisone group and 355 in the placebo group were available for analysis. Compared to placebo, use of prednisone was associated with reductions in levels of CRP on days 3, 5, and 7 (mean difference of 46%, P < .001 for each time point). For PCT, no such difference was observed. Leukocyte and neutrophil count were higher in the prednisone group at all time points (mean difference of 27% for leukocytes and 33% for neutrophils, P <.001 for all time points). We conclude that after administration of glucocorticoids in community-acquired pneumonia, patients had lower CRP levels and increased leukocyte and neutrophil count as compared to the placebo group. PCT levels were not different between treatment groups. PCT levels thus may more appropriately mirror the resolution of infection compared to more traditional inflammatory markers.

• Authors: Natalie Raess, Philipp Schuetz, Nicole Cesana-Nigro, Bettina Winzeler, Sandrine A Urwyler, Sabine Schaedelin, Nicolas Rodondi, Manuel R Blum, Matthias Briel, Beat Mueller, Mirjam Christ-Crain, Claudine A Blum
• Journal: Journal of clinical pharmacology (J Clin Pharmacol) Vol. 61 Issue 11 Pg. 1406-1414 (11 2021) ISSN: 1552-4604 [Electronic] England
• PMID: 34031890 (Publication Type: Journal Article, Multicenter Study, Randomized Controlled Trial, Research Support, Non-U.S. Gov't)
• Copyright: © 2021 The Authors. The Journal of Clinical Pharmacology published by Wiley Periodicals LLC on behalf of American College of Clinical Pharmacology.

Chemical References

• Biomarkers, Pharmacological
• Glucocorticoids
• Procalcitonin
• C-Reactive Protein
• Prednisone

Topics

• Aged, 80 and over
• Analysis of Variance
• Biomarkers, Pharmacological (blood)
• C-Reactive Protein (analysis)
• COVID-19 (epidemiology)
• Community-Acquired Infections (drug therapy, epidemiology)
• Drug Monitoring (methods)
• Female
• Glucocorticoids (administration & dosage)
• Humans
• Leukocyte Count (methods)
• Male
• Pneumonia (blood, drug therapy, epidemiology, etiology)
• Prednisone (administration & dosage)
• Procalcitonin (blood)
• SARS-CoV-2
• Statistics, Nonparametric
• COVID-19 Drug Treatment