How Long Should we Give Steroids for Patients With Severe PCP

What this study is about

The HOW LONG trial is an international, multicenter, Phase IV randomized clinical trial evaluating the optimal duration of adjunctive systemic corticosteroids in immunocompromised adults with severe Pneumocystis jirovecii pneumonia (PCP) who demonstrate early clinical recovery. Participants who no longer require supplemental oxygen by day 10 of corticosteroid therapy are randomized to discontinue corticosteroids at day 10 (or hospital discharge, if earlier) versus continue corticosteroids for a total of 21 days. The trial assesses whether earlier discontinuation reduces steroid-related complications while maintaining clinical outcomes.

Who can join (things the study team will check)

✅ You may be able to join if…

• Age ≥18 years
• Proven or probable Pneumocystis jirovecii pneumonia
• Severe PCP requiring supplemental oxygen (e.g., ≥4 L/min or ≥35% FiO₂ to maintain SpO₂ ≥94%)
• Planned or receiving adjunctive systemic corticosteroid therapy for severe PCP
• Clinical recovery by day 10 of steroid therapy: breathing room air for ≥6 hours
• Able to provide informed consent (or per local requirements)

🚫 You may not be able to join if…

• Persistent hypoxemia or ongoing oxygen requirement at day 10
• Clinical deterioration prior to randomization
• Treating clinician determines steroids must be continued or stopped immediately for medical reasons
• Anticipated death within 48 hours
• Inability or unwillingness to complete follow-up through day 180

Where this trial is running

• McGill university Health Centre (Royal victoria Hospital and Montreal General Hospital, Montreal, Quebec, Canada

Who to contact

Babykumari Chitramuthu, PhD · 15149341934 · babykumari.chitramuthu@muhc.mcgill.ca

It's completely normal to call and ask questions before deciding anything. Mention the study ID: NCT07328984.