Adjunctive corticosteroids in non-HIV immunocompromised patients with Pneumocystis jirovecii pneumonia: a…

Meta-analysisTherapeutic advances in infectious disease· Jan 2026

Adjunctive corticosteroids in non-HIV immunocompromised patients with Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis.

Gustavo Rosales-Chavez, Pedro Martínez-Ayala, Mauricio Alfredo Ambriz-Alarcón … Jaime Briseno-Ramirez

Infectious DiseaseMeta-analysisTreatmentQ2IF 3.5

Corticosteroids reduced invasive mechanical ventilation in a randomized trial of non-HIV pneumocystis pneumonia.

Adjunctive corticosteroids in non-HIV immunocompromised patients with Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis.

Gustavo Rosales-Chavez … Jaime Briseno-Ramirez

Therapeutic advances in infectious disease · Jan 2026

Background

Adjunctive corticosteroids are standard in HIV-pneumocystis jirovecii pneumonia but remain contested in non-HIV pneumocystis jirovecii pneumonia.

Purpose

To determine whether adjunctive corticosteroids reduce mortality and invasive mechanical ventilation (invasive mechanical ventilation) in non-HIV pneumocystis jirovecii pneumonia, and whether effect estimates differ between randomized and observational study designs.

Methods

Systematic review and meta-analysis.

n = 5300 patients

Results

steroids sharply lowered the risk of needing invasive ventilation

HR 0.36 (95% CI 0.14 to 0.90)

CI excludes the null - significant

More results

Evidence was discordant by design (interaction p = 0 .

Pre-specified mortality pools were non-significant short-term (OR 1.22, 0.88-1.70) and intermediate-term (OR 1.39, 0.85-2.29).

Secondary infections ( k = 4 ): OR 1.04 (0.63-1.72); randomized controlled trial 0.59 (0.32-1.06).

More results

E -values for randomized controlled trial effects (3.44 invasive mechanical ventilation; 2.24 mortality) exceeded the 1.81 E -value of the adjusted observational mortality pool.

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Conclusion · 1 of 2

Reliable inference rests on the single randomized controlled trial rather than the pooled observational estimate, which is discordant by design and most consistent with confounding by indication.

Conclusion · 2 of 2

In the randomized controlled trial, corticosteroids did not significantly reduce 28-day mortality but lowered invasive mechanical ventilation and 90-day mortality and sped respiratory recovery, without clear excess secondary infections (low certainty).

Adjunctive corticosteroids in non-HIV immunocompromised patients with Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis.

Adjunctive corticosteroids in non-HIV immunocompromised patients with Pneumocystis jirovecii pneumonia: a systematic review and meta-analysis.

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