Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: A randomized clinical trial

Torres, Antoni; Sibila, Oriol; Ferrer, Miquel; Mendendez, Rosario; Gabarrús, Albert; Sellarés, Jacobo; Restrepo, Marcos I.; Anzueto, Antonio; Niederman, Nichael; Agustı́, Carlos; Polverino, Eva

doi:10.1183/13993003.congress-2015.oa3267

Cited by 145 publications

(201 citation statements)

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“…However, several immunomodulators have been shown as beneficial during acute pneumonia. A short course of corticosteroid has been shown to hasten clinical improvement or reduce treatment failure in doubleblind randomized placebo-controlled trials (Blum et al, 2015;Torres et al, 2015). The rapamycin inhibitor sirolimus, an immunomodulator frequently used in transplant recipients, was shown to improve the outcome of patients in addition to corticosteroid in a randomized controlled trial involving patients with severe A(H1N1) pneumonia ( Wang et al, 2014a).…”

Section: Discussionmentioning

confidence: 99%

Mycophenolic acid, an immunomodulator, has potent and broad-spectrum in vitro antiviral activity against pandemic, seasonal and avian influenza viruses affecting humans

Mok

Chan

et al. 2016

Journal of General Virology

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Section: Discussionmentioning

confidence: 99%

Mycophenolic acid, an immunomodulator, has potent and broad-spectrum in vitro antiviral activity against pandemic, seasonal and avian influenza viruses affecting humans

Mok

Chan

et al. 2016

Journal of General Virology

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“…A 2015 study by Torres and colleagues found that corticosteroid treatment in patients with severe community-acquired pneumonia and high inflammatory response (C-reactive protein . 15 mg/dl) reduced the composite outcome of treatment failure (51). Because of the narrow inclusion criteria, the study took 8 years to complete enrollment, and a larger study will still be needed to confirm mortality benefit.…”

Section: Incorporating Of Biomarkers For Therapy Responsiveness Into mentioning

confidence: 99%

Toward Smarter Lumping and Smarter Splitting: Rethinking Strategies for Sepsis and Acute Respiratory Distress Syndrome Clinical Trial Design

Prescott

Calfee

Thompson

et al. 2016

Am J Respir Crit Care Med

265

237

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Both quality improvement and clinical research efforts over the past few decades have focused on consensus definition of sepsis and acute respiratory distress syndrome (ARDS). Although clinical definitions based on readily available clinical data have advanced recognition and timely use of broad supportive treatments, they likely hinder the identification of more targeted therapies that manipulate select biological mechanisms underlying critical illness. Sepsis and ARDS are by definition heterogeneous, and patients vary in both their underlying biology and their severity of illness. We have long been able to identify subtypes of sepsis and ARDS that confer different prognoses. The key is that we are now on the verge of identifying subtypes that may confer different response to therapy. In this perspective, inspired by a 2015 American Thoracic Society International Conference Symposium entitled "Lumpers and Splitters: Phenotyping in Critical Illness," we highlight promising approaches to uncovering patient subtypes that may predict treatment responsiveness and not just differences in prognosis. We then discuss how this information can be leveraged to improve the success and translatability of clinical trials by using predictive enrichment and other design strategies. Last, we discuss the challenges and limitations to identifying biomarkers and endotypes and incorporating them into routine clinical practice.

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“…Administration of corticosteroids is recognized to have a positive effect on severe CAP, not only showing a shorter median time to clinical stability [15], but also showing a reduction in the risk of treatment failure [16]. It has been pointed out that an inflammatory cytokine excessively produced by immune cells at the initial response to antigen affected progressing ARDS.…”

Section: Treatmentmentioning

confidence: 99%

Clinical Feature: Community-acquired Pneumonia Caused by Panton-Valentine Leukocidin-positive Staphylococcus aureus

Fujisaki¹,

Nakao²,

Okamoto³

et al. 2016

Intensive & Crit Care

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Effect of corticosteroids on treatment failure among hospitalized patients with severe community-acquired pneumonia and high inflammatory response: A randomized clinical trial

Cited by 145 publications

References 0 publications

Mycophenolic acid, an immunomodulator, has potent and broad-spectrum in vitro antiviral activity against pandemic, seasonal and avian influenza viruses affecting humans

Mycophenolic acid, an immunomodulator, has potent and broad-spectrum in vitro antiviral activity against pandemic, seasonal and avian influenza viruses affecting humans

Toward Smarter Lumping and Smarter Splitting: Rethinking Strategies for Sepsis and Acute Respiratory Distress Syndrome Clinical Trial Design

Clinical Feature: Community-acquired Pneumonia Caused by Panton-Valentine Leukocidin-positive Staphylococcus aureus

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