Prednisolone has the same cardiovascular risk profile as hydrocortisone in glucocorticoid replacement

Abstract

IntroductionPatients who need glucocorticoid replacement in both primary and secondary adrenal insufficiency (AI) have the choice of either once-daily prednisolone or thrice-daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers including glucose, weight, body mass index, systolic and diastolic blood pressure and waist circumference, although an increase in cholesterol and low-density lipoprotein (LDL) was suggested in a subgroup of these patients. The aim of this study was to expand the evidence base for the use of these agents as replacement therapy.MethodsData from 82 patients on hydrocortisone and 64 patients on prednisolone for AI at Imperial College Healthcare NHS Trust were analysed.ResultsThere was no significant difference in total cholesterol, LDL levels or any other risk factors between hydrocortisone and prednisolone patients. Prednisolone was subjectively significantly more convenient than hydrocortisone (P = 0.048).ConclusionsPrednisolone once daily is more convenient than hydrocortisone thrice daily, and there is no difference in the markers of cardiovascular risk measured. Because prednisolone mimics the circadian rhythm better than other glucocorticoids, it should be considered as an alternative to hydrocortisone for AI.

Improving glucocorticoid replacement profiles in adrenal insufficiency

“…25 It is however clear that previously used doses have been excessive and 3-4 mg once daily is sufficient replacement in most patients. 26,27 Currently, there are two NIHR adopted studies actively recruiting, comparing lowdose prednisolone with standard regimens of hydrocortisone. 28,29 Low-dose prednisolone has been shown to be superior in reducing androgens, 17-hydroxy progesterone and improving growth velocity in patients with congenital adrenal hyperplasia compared to thricedaily hydrocortisone.…”

“…Further data from a prospective observational study in Germany recorded the frequency of crises experienced by patients on different treatment regimens, and showed that the proportion of patients on prednisolone experiencing a crisis was not greater than expected . It is however clear that previously used doses have been excessive and 3‐4 mg once daily is sufficient replacement in most patients . Currently, there are two NIHR adopted studies actively recruiting, comparing low‐dose prednisolone with standard regimens of hydrocortisone .…”

Inadvertent treatment of hypoadrenalism with prednisolone in pemphigus: A case report

“…This patient's experience confirms recent evidence that the dose required for adequate replacement is far less than the 7.5 mg traditionally quoted. If prednisolone is to be used as replacement glucocorticoid, we recommend a starting dose of 3‐4 mg daily …”

Glucocorticoid replacement in Addison disease

“…There is evidence that it is at least not inferior to the currently most widely used therapy, thrice-daily hydrocortisone 2 .…”