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Corticothérapie systémique et pneumopathies communautaires : où en est-on ?

Corticosteroids as adjunctive treatment for community-acquired pneumonia: Where are we?

Résumé

Les pneumopathies aiguës communautaires (PAC) sont fréquentes et exposent dans les formes sévères à une mortalité élevée. Les corticostéroïdes (CTx) pourraient en améliorer le pronostic grâce à leurs propriétés immunomodulatrices et anti-inflammatoires. Quelques essais randomisés ont suggéré qu’un traitement adjuvant par CTx pourrait accélérer la guérison des PAC et diminuer leur durée d’hospitalisation. Plusieurs méta-analyses ont même suggéré une amélioration de la survie dans les formes sévères de PAC, mais elles sont fondées sur un petit nombre d’essais regroupant moins de 400 patients. À ce jour, les CTx ne peuvent donc être recommandés dans le traitement adjuvant des PAC, mais plusieurs essais randomisés sont en cours dont deux en réanimation, qui devraient aider à préciser leur place thérapeutique.

Abstract

Mortality of severe community-acquired pneumonia (CAP) has not declined over time and is between 25 and 30% in sub-groups of patients. Corticosteroids (CTx) could down-regulate pulmonary and systemic inflammation, accelerate clinical resolution and decrease the rate of inflammation-associated systemic complications. Some randomized controlled trials have suggested that CTx could decrease time to clinical stability and length of stay. Recent meta-analyses suggest an increase in severe CAP survival when CTx are added to standard therapy. However they are based on very few trials gathering less than 400 patients. At this time, guidelines do not recommend CTx as part of CAP treatment. However well-powered trials are underway and will hopefully help to answer this question.

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Références

  1. Almirall J, Bolíbar I, Vidal J, Sauca G, Coll P, Niklasson B, Bartolomé M, Balanzó X, (2000) Epidemiology of community-acquired pneumonia in adults: a population-based study. Eur Resp J 15: 757–763

    CAS  Article  Google Scholar 

  2. Ewig S, Birkner N, Strauss R, Schaefer E, Pauletzki J, Bischoff H, Schraeder P, Welte T, Hoeffken G, (2009) New perspectives on community-acquired pneumonia in 388,406 patients. Results from a nationwide mandatory performance measurement program in healthcare quality. Thorax 64: 1062–1069

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  3. Restrepo M, Jorgensen, JH, Mortensen EM, Anzueto A, (2001) Severe community-acquired pneumonia: current outcomes, epidemiology, etiology and therapy. Curr Opin Infect Dis 14: 703–709

    CAS  Article  PubMed  Google Scholar 

  4. National Heart, Lung, and Blood Institute. Morbidity and mortality: 2012 chart book on cardiovascular, lung, and blood diseases. Bethesda, Maryland: US Department of Health and Human Services. Public Health Service. National Institutes of Health; 2012 www.nhlbi.nih.gov/resources/docs/2012_ChartBook.pdf Accessed October 30, 2016.

  5. Niederman MS, McCombs JS, Unger AN, Kumar A, Popovian R, (1998) The cost of treating community-acquired pneumonia. Clin Ther 20: 820–837

    CAS  Article  PubMed  Google Scholar 

  6. Blum CA, Nigro N, Briel M, Schuetz P, Ullmer E, Suter-Widmer I, Winzeler B, Bingisser R, Elsaesser H, Drozdov D, Arici B, Urwyler SA, Refardt J, Tarr P, Wirz S, Thomann R, Baumgartner C, Duplain H, Burki D, Zimmerli W, Rodondi N, Mueller B, Christ-Crain M, (2015) Adjunct prednisone therapy for patients with community-acquired pneumonia: a multicentre, double-blind, randomized, placebo-controlled trial. Lancet 385: 1511–1518

    CAS  Article  PubMed  Google Scholar 

  7. Torres A, Sibila O, Ferrer M, Polverino E, Menendez R, Mensa J, Gabarrus A, Sellares J, Restrepo MI, Anzueto A, Niederman MS, Agusti C, (2015) Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: a randomized clinical trial. JAMA 313: 677–686

    CAS  Article  PubMed  Google Scholar 

  8. Angus DC, Marrie TJ, Obrosky DS, Clermont G, Dremsizov TT, Coley C, Fine MJ, Singer DE, Kapoor WN, (2002) Severe community-acquired pneumonia: use of intensive care services and evaluation of American and British Thoracic Society diagnostic criteria. Am J Respir Crit Care Med 166: 717–723

    Article  PubMed  Google Scholar 

  9. Leroy O, Santré C, Beuscart C, Georges H, Guery B, Jacquier JM, Beaucaire G, (1995) A five-year study of severe communityacquired pneumonia with emphasis on prognosis in patients admitted to an intensive care unit. Intensive Care Med 21: 24–31

    CAS  Article  PubMed  Google Scholar 

  10. Fine MJ, Auble TE, Yealy DM, Hanusa BH, Weissfeld LA, Singer DE, Coley CM, Marrie TJ, Kapoor WN, (1997) A prediction rule to identify low-risk patients with community-acquired pneumonia. N Engl J Med 336: 243–250

    CAS  Article  PubMed  Google Scholar 

  11. Lim WS, Van Der Eerden MM, Laing R, Boersma WG, Karalus N, Town GI, Lewis SA, Macfarlane JT, (2003) Defining community acquired pneumonia severity on presentation to hospital: an international derivation and validation study. Thorax 58: 377–382

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  12. Wunderink RG, Laterre PF, Francois B, Perrotin D, Artigas A, Vidal LO, Lobo SM, Juan JS, Hwang SC, Dugernier T, LaRosa S, Wittebole X, Dhainaut JF, Doig C, Mendelson MH, Zwingelstein C, Su G, Opal S, CAPTIVATE Trial Group, (2011) Recombinant Tissue Factor Pathway Inhibitor in severe communityacquired pneumonia: a randomized trial. Am J Respir Crit Care Med 183: 1561–1568

    CAS  Article  PubMed  Google Scholar 

  13. Chalmers JD, (2016) Corticosteroids for community-acquired pneumonia: a critical view of the evidence. Eur Respir J 48: 984–986

    Article  PubMed  Google Scholar 

  14. Coutinho AE, Chapman KE, (2011) The anti-inflammatory and immunosuppressive effects of glucocorticoids, recent developments and mechanistic insights. Mol Cell Endocr 335: 2–13

    CAS  Article  Google Scholar 

  15. Ramamoothy S, Cidlowski J, (2016). Corticosteroids: mechanisms of action in health and disease. Rheum Dis Clin North Am 42: 15–31

    Article  Google Scholar 

  16. Prigent H, Maxime V, Annane D, (2004) Corticotherapy in sepsis. Crit Care 8: 112–119

    Article  Google Scholar 

  17. Wagner HN Jr, Bennett IL Jr, Lasagna L, Cluff LE, Rosenthal MB, Mirick GS, (1956) The effect of hydrocortisone upon the course of pneumococcal pneumonia treated with penicillin. Bull Johns Hopkins Hosp 98: 197–215

    PubMed  Google Scholar 

  18. McHardy VU, Schonell ME, (1972) Ampicillin dosage and use of prednisolone in treatment of pneumonia: co-operative controlled trial. BMJ 4: 569–573

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  19. Marik P, Kraus P, Sribante J, Havlik I, Lipman J, Johnson DW, (1993) Hydrocortisone and tumor necrosis factor in severe community-acquired pneumonia: a randomized controlled study. Chest 104: 389–392

    CAS  Article  PubMed  Google Scholar 

  20. Confalonieri M, Urbino R, Potena A, Piattella M, Parigi P, Puccio G, Della Porta R, Giorgio C, Blasi F, Umberger R, Meduri GU, (2005) Hydrocortisone infusion for severe community-acquired pneumonia: a preliminary randomized study. Am J Respir Crit Care Med 171: 242–248

    Article  PubMed  Google Scholar 

  21. El-Ghamrawy AH, Shokeir MH, Esmat AA, (2006) Effects of low-dose hydrocortisone in ICU patients with severe communityacquired pneumonia. Egypt J Chest Dis Tuberc 55: 91–99

    Google Scholar 

  22. Mikami K, Suzuki M, Kitagawa H, Kawakami M, Hirota N, Yamaguchi H, Narumoto O, Kichikawa Y, Kawai M, Tashimo H, Arai H, Horiuchi T, Sakamoto Y, (2007) Efficacy of corticosteroids in the treatment of community-acquired pneumonia requiring hospitalization. Lung 185: 249–255

    CAS  Article  PubMed  Google Scholar 

  23. Snijders D, Daniels JM, de Graaff CS, van der Werf TS, Boersma WG, (2010) Efficacy of corticosteroids in community-acquired pneumonia: a randomized double-blind clinical trial. Am J Respir Crit Care Med 181: 975–982

    CAS  Article  PubMed  Google Scholar 

  24. Meijvis SC, Hardeman H, Remmelts HH, Heijligenberg R, Rijkers GT, van Velzen-Blad H, Voorn GP, van de Garde EM, Endeman H, Grutters JC, Bos WJ, Biesma DH, (2011) Dexamethasone and length of hospital stay in patients with communityacquired pneumonia: a randomized, double-blinded, placebocontrolled trial. Lancet 377: 2023–2030

    CAS  Article  PubMed  Google Scholar 

  25. Sabry NA, Omar EE, (2011) Corticosteroids and ICU course of community acquired pneumonia in Egyptian settings. Pharmacol Pharm 2: 73–81

    CAS  Article  Google Scholar 

  26. Fernández-Serrano S, Dorca J, Garcia-Vidal C, Fernández-Sabé N, Carratalà J, Fernández-Agüera A, Corominas M, Padrones S, Gudiol F, Manresa F, (2011) Effect of corticosteroids on the clinical course of community-acquired pneumonia: a randomized controlled trial. Crit Care 15: 1–9

    Article  Google Scholar 

  27. Nafae RM, Ragab MI, Amany FM, Rashed SB, (2013) Adjuvant role of corticosteroids in the treatment of community-acquired pneumonia. Egypt J Chest Dis Tuberc 62: 439–445

    Article  Google Scholar 

  28. Wirz SA, Blum CA, Schuetz P, Albrich WC, Noppen C, Mueller B, Christ-Crain M, Tarr PE, (2016) Pathogen and antibioticspecific effects of prednisolone in community-acquired pneumonia. Eur Respir J 48: 1150–1159

    Article  PubMed  Google Scholar 

  29. Ewig S, Ruiz M, Mensa J, Marcos MA, Martinez JA, Arancibia F, Niederman MS, Torres A, (1998) Severe community-acquired pneumonia: assessment of severity criteria. Am J Respir Crit Care Med 158: 1102–1108

    CAS  Article  PubMed  Google Scholar 

  30. Nie W, Zhang Y, Cheng J, Xiu Q, (2012) Corticosteroids in the treatment of community-acquired pneumonia in adults: a metaanalysis. Plos One 7: e47926

    Article  Google Scholar 

  31. Cheng M, Pan ZY, Yang J, Gao YD, (2014) Corticosteroids therapy for severe community-acquired pneumonia: a meta-analysis. Resp Care 59: 557–563

    Article  Google Scholar 

  32. Marti C, Grosgurin O, Harbarth S, Combescure C, Abbas M, Rutschmann O, Perrier A, Garin N, (2015) Adjunctive corticotherapy for community-acquired pneumonia: a systematic review and meta-analysis. PLoS One 10: e0144032

    Google Scholar 

  33. Horita N, Otsuka T, Haranaga S, Namkoong H, Miki M, Miyashita N, Higa F, Takahashi H, Yoshida M, Kohno S, Kaneko T, (2015) Adjunctive systemic corticosteroids for hospitalized communityacquired pneumonia: systematic review and meta-analysis 2015 update. Sci Rep 5: 14061

    CAS  Article  PubMed  PubMed Central  Google Scholar 

  34. Chen LP, Chen JH, Chen Y, Wu C, Yang XH, (2015) Efficacy and safety of glucocorticoids in the treatment of community-acquired pneumonia: a meta-analysis of randomized controlled trials. World J Emerg Med 6: 172–178

    Article  PubMed  PubMed Central  Google Scholar 

  35. Siemieniuk RAC, Meade MO, Alonso-Coello P, Briel M, Evaniew N, Prasad M, Alexander PE, Fei Y, Vandvik PO, Loeb M, Guyatt GH, (2015) Corticosteroid therapy for patients hospitalized with community-acquired pneumonia: a systematic review and meta-analysis. Ann Intern Med 163: 519–528

    Article  PubMed  Google Scholar 

  36. Wan YD, Sun TW, Liu ZQ, Zhang SG, Wang LX, Kan QC, (2016) Efficacy and safety of corticosteroids for communityacquired pneumonia: a systematic review and meta-analysis. Chest 149: 209–219

    Article  PubMed  Google Scholar 

  37. Feldman C, Anderson R, (2016) Corticosteroids in the adjunctive therapy of community-acquired pneumonia: an appraisal of recent meta-analyses of clinical trials. J Thorac Dis 8: e162–171

    Article  Google Scholar 

  38. Tagami T, Matsui H, Horiguchi H, Fushimi K, Yasunaga H, (2014) Low-dose corticosteroid use and mortality in severe community-acquired pneumonia patients. Eur Respir J 45: 463–472

    Article  PubMed  Google Scholar 

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Correspondence to P. F. Dequin.

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Dequin, P.F., pour le réseau TriGGERSep et le groupe CRICS. Corticothérapie systémique et pneumopathies communautaires : où en est-on ?. Méd. Intensive Réa 26, 48–55 (2017). https://doi.org/10.1007/s13546-017-1254-8

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  • DOI: https://doi.org/10.1007/s13546-017-1254-8

Mots clés

  • Pneumopathie aiguë communautaire
  • Corticostéroïdes
  • Réanimation
  • Pronostic
  • Méta-analyses

Keywords

  • Community-acquired pneumonia
  • Corticosteroids
  • Intensive care medicine
  • Prognosis
  • Meta-analysis