Imperial College London
Alternate

PROFESSOR AZEEM MAJEED

Faculty of Medicine, School of Public Health

Chair - Primary Care and Public Health & Head of Department
 
 
 
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Contact

 

+44 (0)20 7594 3368a.majeed Website

 
 
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Assistant

 

Ms Dorothea Cockerell +44 (0)20 7594 3368

 
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Location

 

Reynolds BuildingCharing Cross Campus

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Summary

 

Publications

Citation

BibTex format

@article{Ngaosuwan:2021:clinem/dgab347,
author = {Ngaosuwan, K and Johnston, DG and Godsland, IF and Cox, J and Majeed, A and Quint, JK and Oliver, N and Robinson, S},
doi = {clinem/dgab347},
journal = {Journal of Clinical Endocrinology and Metabolism},
pages = {2242--2251},
title = {Mortality risk in patients with adrenal insufficiency using prednisolone or hydrocortisone: a retrospective cohort study},
url = {http://dx.doi.org/10.1210/clinem/dgab347},
volume = {106},
year = {2021}
}
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RIS format (EndNote, RefMan)

TY  - JOUR
AB  - 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. INTERVENTIONS: Nil. 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.
AU  - Ngaosuwan,K
AU  - Johnston,DG
AU  - Godsland,IF
AU  - Cox,J
AU  - Majeed,A
AU  - Quint,JK
AU  - Oliver,N
AU  - Robinson,S
DO  - clinem/dgab347
EP  - 2251
PY  - 2021///
SN  - 0021-972X
SP  - 2242
TI  - Mortality risk in patients with adrenal insufficiency using prednisolone or hydrocortisone: a retrospective cohort study
T2  - Journal of Clinical Endocrinology and Metabolism
UR  - http://dx.doi.org/10.1210/clinem/dgab347
UR  - https://www.ncbi.nlm.nih.gov/pubmed/33993277
UR  - http://hdl.handle.net/10044/1/91938
VL  - 106
ER  -
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