Comparison of Various Glucocorticoid Replacement Regimens Used in Chronic Adrenal Insufficiency: A Systematic Review
Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15–30 mg/day) and prednisolone (3–7.5 mg/day) are the preferred agents used although there is a lack of consensus among endocrinologists regarding the impact of different steroid regi...
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| Veröffentlicht in: | Dubai Diabetes and Endocrinology Journal Jg. 26; H. 2; S. 50 - 68 |
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S. Karger AG
01.12.2020
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| Abstract | Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15–30 mg/day) and prednisolone (3–7.5 mg/day) are the preferred agents used although there is a lack of consensus among endocrinologists regarding the impact of different steroid regimens on quality of life, bone metabolism, cardiometabolic outcomes, adrenal crisis and infections. We carried out a retrospective systematic review of the literature to compare the efficacy and side effects of various glucocorticoid replacement regimens in patients with chronic adrenal insufficiency. Methods: We searched PubMed, Cochrane Reviews and Google Scholar databases up to March 14, 2019, for studies evaluating various clinical outcomes with glucocorticoid replacement therapy. The abstracts and full studies were appraised and data extracted from the eligible studies. The quality of evidence was evaluated and risk of bias carried out. Results: A total of 47 studies including 9 randomised controlled trials (RCTs) and 38 observational studies were evaluated in this systematic review. Prednisolone therapy was observed to be safe as well as efficacious as hydrocortisone although a higher dose was associated with an increased risk of cardiovascular (CV) disease. A lower hydrocortisone dose (15–20 mg/day) was associated with a reduction of blood pressure and improved clinical outcomes although this observation was based on a solitary RCT. Modified release hydrocortisone was observed to reduce the risk of CV disease based upon results from 2 of the RCTs. However, there was no conclusive evidence of benefit of modified release hydrocortisone and continuous subcutaneous hydrocortisone infusion in improving subjective health status. Conclusion: Prednisolone therapy remains a safe and efficacious alternative to hydrocortisone although there are concerns of dyslipidaemia and CV disease with higher doses. There is limited level I evidence suggestive of a positive effect of modified release hydrocortisone on CV and metabolic outcomes, particularly weight reduction. |
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| AbstractList | Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15-30 mg/day) and prednisolone (3-7.5 mg/day) are the preferred agents used although there is a lack of consensus among endocrinologists regarding the impact of different steroid regimens on quality of life, bone metabolism, cardiometabolic outcomes, adrenal crisis and infections. We carried out a retrospective systematic review of the literature to compare the efficacy and side effects of various glucocorticoid replacement regimens in patients with chronic adrenal insufficiency. Methods: We searched PubMed, Cochrane Reviews and Google Scholar databases up to March 14, 2019, for studies evaluating various clinical outcomes with glucocorticoid replacement therapy. The abstracts and full studies were appraised and data extracted from the eligible studies. The quality of evidence was evaluated and risk of bias carried out. Results: A total of 47 studies including 9 randomised controlled trials (RCTs) and 38 observational studies were evaluated in this systematic review. Prednisolone therapy was observed to be safe as well as efficacious as hydrocortisone although a higher dose was associated with an increased risk of cardiovascular (CV) disease. A lower hydrocortisone dose (15-20 mg/day) was associated with a reduction of blood pressure and improved clinical outcomes although this observation was based on a solitary RCT. Modified release hydrocortisone was observed to reduce the risk of CV disease based upon results from 2 of the RCTs. However, there was no conclusive evidence of benefit of modified release hydrocortisone and continuous subcutaneous hydrocortisone infusion in improving subjective health status. Conclusion: Prednisolone therapy remains a safe and efficacious alternative to hydrocortisone although there are concerns of dyslipidaemia and CV disease with higher doses. There is limited level I evidence suggestive of a positive effect of modified release hydrocortisone on CV and metabolic outcomes, particularly weight reduction. Keywords: Glucocorticoid, Outcomes, Adrenal, Insufficiency Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15–30 mg/day) and prednisolone (3–7.5 mg/day) are the preferred agents used although there is a lack of consensus among endocrinologists regarding the impact of different steroid regimens on quality of life, bone metabolism, cardiometabolic outcomes, adrenal crisis and infections. We carried out a retrospective systematic review of the literature to compare the efficacy and side effects of various glucocorticoid replacement regimens in patients with chronic adrenal insufficiency. Methods: We searched PubMed, Cochrane Reviews and Google Scholar databases up to March 14, 2019, for studies evaluating various clinical outcomes with glucocorticoid replacement therapy. The abstracts and full studies were appraised and data extracted from the eligible studies. The quality of evidence was evaluated and risk of bias carried out. Results: A total of 47 studies including 9 randomised controlled trials (RCTs) and 38 observational studies were evaluated in this systematic review. Prednisolone therapy was observed to be safe as well as efficacious as hydrocortisone although a higher dose was associated with an increased risk of cardiovascular (CV) disease. A lower hydrocortisone dose (15–20 mg/day) was associated with a reduction of blood pressure and improved clinical outcomes although this observation was based on a solitary RCT. Modified release hydrocortisone was observed to reduce the risk of CV disease based upon results from 2 of the RCTs. However, there was no conclusive evidence of benefit of modified release hydrocortisone and continuous subcutaneous hydrocortisone infusion in improving subjective health status. Conclusion: Prednisolone therapy remains a safe and efficacious alternative to hydrocortisone although there are concerns of dyslipidaemia and CV disease with higher doses. There is limited level I evidence suggestive of a positive effect of modified release hydrocortisone on CV and metabolic outcomes, particularly weight reduction. |
| Audience | Academic |
| Author | Kiko, Nduku Kalhan, Atul |
| Author_xml | – sequence: 1 givenname: Nduku surname: Kiko fullname: Kiko, Nduku email: *Nduku Kiko, Department of Medicine, Kenyatta National Hospital, PO Box 1203-00600, Nairobi 00600 (Kenya), ne.kiko@yahoo.com – sequence: 2 givenname: Atul surname: Kalhan fullname: Kalhan, Atul |
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| Cites_doi | 10.3389/fpsyg.2017.00764 10.1016/S2213-8587(17)30398-4 10.1507/endocrj.51.355 10.1210/jc.2014-3191 10.1159/000442985 10.1530/EJE-14-0023 10.1136/bmj.d5928 10.1016/j.ando.2014.11.004 10.1111/cen.12484 10.1530/EJE-17-0128 10.1159/000486004 10.1111/joim.12162 10.1210/jc.2013-4253 10.1530/EJE-09-0884 10.1210/jc.2006-0076 10.1111/cen.12670 10.1210/jc.2011-1926 10.1530/EJE-08-0880 10.1530/EC-17-0368 10.1530/EJE-14-0327 10.1007/s12020-017-1512-1 10.1038/sj.ijo.0801276 10.1186/1472-6823-12-8 10.4158/EP161428.OR 10.1530/EC-16-0081 10.1530/EC-18-0160 10.1007/s12020-015-0681-z 10.1210/jc.2011-2036 10.1097/MAJ.0b013e3181db6b7a 10.1530/EJE-14-1114 10.4158/EP151014.OR 10.1111/j.1365-2265.2011.04174.x 10.1210/jc.2007-0685 10.1016/S2213-8587(14)70142-1 10.1055/s-0029-1211215 10.1210/jc.2006-0524 10.1007/s001980050251 10.1530/EJE-14-0397 10.1111/cen.12865 10.1111/cen.13059 10.1371/journal.pmed.1000097 10.1007/s12020-010-9359-8 10.1530/EJE-07-0052 10.1210/jc.2015-1710 10.1530/EC-17-0257 10.1530/EJE-15-1096 10.1055/s-0032-1331766 10.1210/jc.2014-2433 10.1016/j.psyneuen.2016.06.015 10.1007/s11102-008-0126-2 10.1530/EC-18-0418 10.1530/EJE-12-0351 10.1210/jc.2014-4328 10.1530/EJE-17-0067 10.1530/EJE-08-0578 10.1007/s10484-016-9338-9 |
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| Keywords | Adrenal Glucocorticoid Outcomes Insufficiency |
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| References_xml | – reference: Riedel M, Wiese A, Schürmeyer TH, Brabant G. Quality of life in patients with Addison’s disease: effects of different cortisol replacement modes. Exp Clin Endocrinol. 1993;101(2):106–11. 10.1055/s-0029-121121584051390232-7384 – reference: Husebye ES, Allolio B, Arlt W, Badenhoop K, Bensing S, Betterle C, et al.. Consensus statement on the diagnosis, treatment and follow-up of patients with primary adrenal insufficiency. J Intern Med. 2014Feb;275(2):104–15. 10.1111/joim.12162243300300954-6820 – reference: Andela CD, Staufenbiel SM, Joustra SD, Pereira AM, van Rossum EF, Biermasz NR. Quality of life in patients with adrenal insufficiency correlates stronger with hydrocortisone dosage, than with long-term systemic cortisol levels. Psychoneuroendocrinology. 2016Oct;72:80–6. 10.1016/j.psyneuen.2016.06.015273886870306-4530 – reference: Heald AH, Walther A, Davis JR, Moreno GY, Kane J, Livingston M, et al.. 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| Snippet | Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15–30 mg/day) and prednisolone (3–7.5... Objective: Patients with adrenal insufficiency require life-long glucocorticoid replacement therapy. Hydrocortisone (15-30 mg/day) and prednisolone (3-7.5... |
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| Title | Comparison of Various Glucocorticoid Replacement Regimens Used in Chronic Adrenal Insufficiency: A Systematic Review |
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