Context: Patients with adrenal insufficiency (AI) receive glucocorticoid replacement therapy, which tries to imitate physiological adrenal secretion. However, the first glucocorticoid dose is usually given after waking in the morning resulting in a 35 h delay compared to physiological secretion. Impaired quality of life (QoL) might be, in part, due to this delayed dose scheme. Therefore, modified-release glucocorticoid preparations might have therapeutical advantages.
Objectives: Does modified-release prednisolone improve QoL compared to standard prednisolone? Design and Patients: Prospective case series including 13 patients with primary and 1 patient with secondary AI in a single university center. AI patients on morning dose prednisolone (5 mg) were included, switched to modified-release prednisolone (5 mg) at 10 pm for three months, then switched back on standard prednisolone. Two standardized QoL questionnaires (GBB-24 and MFI) were completed at baseline, after 3 and 6 months. Data regarding clinical and hormonal parameters were assessed. Main Outcome Measures: Changes in QoL depending on the prednisolone formulation.
Results: Modified-release prednisolone showed in one of four scales of the GBB-24 a significant improvement (exhaustion tendency) and in three of four scales a positive trend to better scores. The global score of discomfort (sum of four scales) improved significantly. The MFI showed also significant improvement in three scales and a positive trend to better scores in two of five scales.
Conclusions: Modified-release prednisolone showed improved QoL compared to standard prednisolone indicating the importance of the glucocorticoid increase in the early morning hours before waking.
Declaration of interest: There is no conflict of interest that could be perceived as prejudicing the impartiality of the research reported.
Funding: No specific grant from any funding agency in the public, commercial or not-for-profit sector.