RCT

PIC

Adjunctive corticosteroids in non-AIDS patients with severe Pneumocystis jirovecii pneumonia

Lancet Respir Med, 2025 · Multicenter double-blind randomized placebo-controlled trial

Clinical question

Do adjunctive corticosteroids reduce mortality in HIV-negative immunocompromised adults with PJP and acute hypoxemic respiratory failure?

Population: HIV-negative adults with microbiologically documented PJP and acute hypoxemic respiratory failure
Intervention: Adjunctive 21-day methylprednisolone regimen plus anti-Pneumocystis therapy
Comparator: Placebo plus anti-Pneumocystis therapy
Primary outcome: 28-day all-cause mortality
Result: 28-day mortality was 21.5% with corticosteroids vs 32.4% with placebo; the prespecified difference did not reach statistical significance (p=0.069).

What the trial found

The trial did not demonstrate a statistically significant 28-day mortality benefit from routine adjunctive corticosteroids in HIV-negative hypoxemic PJP.

Current guideline position

Evidence in non-HIV PJP remains uncertain; routine adjunctive corticosteroids are not supported by this RCT alone.

Clinical interpretation

Do not automatically apply the established HIV-associated PJP steroid rule to non-HIV PJP; individualize adjunctive corticosteroids and avoid assuming higher doses improve outcomes.

Clinical Context & Relevant Topics (1)

Disease Reference

Immunocompromised & Oncologic Critical Illness

Host immune defects, neutropenic sepsis, acute respiratory failure (PJP/Aspergillus), tumor lysis syndrome, leukostasis, CAR-T CRS/ICANS, and ICU triage.

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