Comparing shorter and longer steroid treatment for severe Pneumocystis pneumonia
Compares stopping steroids at day 10 or continuing to 21 days in adults.
Plain-language title generated from the registry record
Registry title: How Long Should we Give Steroids for Patients With Severe PCP
Key facts
- Where
- Montreal, CanadaSee the site
- Phase
- Phase 4
Where in Canada
- McGill university Health Centre (Royal victoria Hospital and Montreal General HospitalMontreal, CanadaNo longer taking part
Questions to ask the study team
- How often do I need to come in, and for how long each time?
- Are travel costs paid?
- Can I keep my own doctor?
- What happens if I want to stop?
Trial details
- Who runs it
- McGill University Health Centre/Research Institute of the McGill University Health Centre
- Trial code
- NCT07328984
- Record updated
- 9 January 2026
- Original description
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.Read full original descriptionShow less
How Long Should we Give Steroids for Patients With Severe PCP (HOW LONG)
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.
Inclusion: 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).
Exclusion: Clinical deterioration prior to randomization; Treating clinician determines steroids must be continued or stopped immediately for medical reasons; Persistent hypoxemia or ongoing oxygen requirement at day 10; Anticipated death within 48 hours; Inability or unwillingness to complete follow-up through day 180.