Full Mortality risk in patients with adrenal insufficiency using Prednisolone or Hydrocortisone: A Retrospective Cohort study.
CONTEXT: Prednisolone has been recommended rather than hydrocortisone for glucocorticoid replacement in adrenal insufficiency due its longer duration of action and lower cost.
OBJECTIVE: To determine mortality rates with prednisolone versus hydrocortisone.
DESIGN: Observational study.
SETTING: A UK primary care database (Clinical Practice Research Datalink).
PARTICIPANTS: Patients with primary and secondary adrenal insufficiency, treated with either prednisolone or hydrocortisone, and controls individually matched for age, sex, period and place of follow-up.
OUTCOMES: Mortality relative to individually matched controls.
RESULTS: As expected, mortality in adrenal insufficiency irrespective of cause was increased, based on 5478 patients (4228 on hydrocortisone; 1250 on prednisolone) and 54314 controls (41934 and 12380, respectively). Overall, the adjusted hazard ratio (HR) was similar with the two treatments (prednisolone, 1.76 [95% CI, 1.54-2.01] vs. hydrocortisone 1.69 [1.57-1.82]; p=0.65). This was also the case for secondary adrenal insufficiency. In primary disease (1405 on hydrocortisone vs. 137 on prednisolone:13965 and 1347 controls, respectively), prednisolone-users were older, more likely to have another autoimmune disease and malignancy, and less likely to have mineralocorticoid replacement. Nevertheless, after adjustment, the HR for prednisolone-treated patients remained higher than for those taking hydrocortisone (2.92 [2.19-3.91] vs. 1.90 [1.66-2.16]; p=0.0020).
CONCLUSIONS: In primary but not in secondary adrenal insufficiency mortality was higher with prednisolone. The study was large, but the number of prednisolone-treated patients was small, and they had greater risk factors. Nonetheless the increased mortality associated with prednisolone persisted despite statistical adjustment. Further evidence is needed regarding the long-term safety of prednisolone as routine replacement.
|投稿者||Ngaosuwan, Kanchana; Johnston, Desmond G; Godsland, Ian F; Cox, Jeremy; Majeed, Azeem; Quint, Jennifer K; Oliver, Nick; Robinson, Stephen|
|ジャーナル名||The Journal of clinical endocrinology and metabolism|
|組織名||Department of Metabolism, Digestion and Reproduction, Faculty of Medicine,;Imperial College, London, UK.;Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical;Science, Chulabhorn Royal Academy, Bangkok, Thailand.;Department of Metabolic Medicine, St. Mary's Hospital, Imperial College NHS;trust, London, UK.;School of Public Health, Imperial College, London, UK.;National Heart and Lung Institute, Imperial College, London, UK.|