Chinese Medicine Reduces Treatment Failure in Elderly Patients with Severe Community-Acquired Pneumonia: A Post-Hoc Analysis of a Randomized Controlled Trial.

OBJECTIVE: To explore the effectiveness and safety of Chinese medicine (CM) treatment based on pattern identification (PI) in elderly patients (⩾ 60 years) with severe community-acquired pneumonia (CAP). METHODS: This post hoc analysis was based on a multicenter, randomized, placebo-controlled trial. Elderly patients with severe CAP were randomly assigned to receive either conventional medicine plus CM placebo (conventional group) or conventional medicine combined with CM treatment based on PI (combination group) for a 28-d treatment period. The primary outcome was the rate of treatment failure. Secondary outcomes included 28- and 90-d mortality, time to clinical stability, rate of clinical stability, length of hospital stay, and adverse events. RESULTS: A total of 128 elderly patients with severe CAP were included in the intention-to-treat population, comprising 67 patients in the combination group and 61 in the conventional group. The rate of treatment failure was lower in the combination group than in the conventional group (20.9% vs. 39.3%), with a between-group difference of 18% [95% confidence interval (CI), 0.03-0.34; P<0.05]. The 28-d mortality in the combination group was lower than that in the conventional group (19.4% vs. 36.1%), with a difference of 17% (95% CI, 0.01-0.32; P<0.05). Time to clinical stability was significantly shorter in the combination group than in the conventional group, with a Hazard ratio of 2.44 (95% CI, 1.44-4.14; P<0.01). The rate of clinical stability was higher in the combination group than in the conventional group (64.2% vs. 34.4%), with the between-group difference was 30% (95% CI, 0.13-0.46; P<0.01). Similar results were observed in the per-protocol population. The incidence of adverse events was similar between combination and conventional groups. CONCLUSION: The combination of conventional medicine with CM treatment based on PI was effective and safe in reducing treatment failure among elderly patients with severe CAP compared with conventional medicine alone.