ECE2021 Oral Communications Oral Communications 1: Adrenal and Cardiovascular Endocrinology (6 abstracts)
1Faculty of Medicine and Public Health, HRH Princess Chulabhorn College of Medical Science, Chulabhorn Royal Academy, Bangkok, Thailand; 2Faculty of Medicine, Imperial College, Metabolism, Digestion and Reproduction, London, United Kingdom; 3Imperial NHS Trust, London, United Kingdom; 4School of Public Health, Imperial College, London, United Kingdom; 5National Heart and Lung Institute, Imperial College, London, United Kingdom
Background
Whilst hydrocortisone is standard glucocorticoid replacement therapy in patients with adrenal insufficiency, some have considered prednisolone an alternative. Some data have shown diabetes and osteoporosis risk. Mortality of patients using prednisolone in relation with those using hydrocortisone is not known. We compared all-cause mortality risk compared to matched controls in patients with primary or secondary adrenal insufficiency using prednisolone or hydrocortisone.
Subjects
In hydrocortisone cohort, 4228 patients with adrenal insufficiency of any type (1, 405 primary adrenal insufficiency, 2, 461 secondary) were compared with 41, 934 matched controls (13, 965 primary, 24, 401 secondary). In prednisolone cohort, 1, 250 adrenal insufficiency patients (137 primary, 897 secondary) were compared with 12, 380 matched controls (1, 347 primary, 8909 secondary).
Methods
Participants were extracted from a UK general practitioner database (Clinical Practice Research Datalink; CPRD) from 1987 to 2017. Each study patient was matched with up to 10 controls who had the same sex, GP practice, 5-year strata of the year of birth, and 5-year strata of the start of follow-up. Follow-up began on the latest of the date at which patients were diagnosed, registered to GP, or the GP provided standard information. Follow-up finished on the earliest date of death, or de-registering from the GP. All-cause mortality risk relative to controls was analysed separately in hydrocortisone and prednisolone cohorts then compared between cohorts.
Results
In adrenal insufficiency of any type, the hazard ratio for mortality of prednisolone users was 1.67 (95% CI, 1.47–1.90) with a follow-up period of 6725 and 66430 person-years for cases and controls, respectively. The HR was not different from that of hydrocortisone users (HR, 1.73 [95% CI, 1.61–1.87]; p for HR difference = 0.69) with a follow-up period of 24574 and 256815 person-years for cases and controls, respectively. In primary adrenal insufficiency, the hazard ratio of prednisolone users was 2.45 (95% CI, 1.86–3.23) which was higher than hydrocortisone users (HR, 1.82 [95% CI, 1.60–2.08]; p for HR difference =0.043). In secondary adrenal insufficiency the hazard ratio of prednisolone users was similar to hydrocortisone users (HR, 1.42 [95% CI, 1.18–1.72] vs. 1.59 [1.44–1.75]; p for HR difference = 0.34).
Conclusion
All-cause mortality risk in patients using prednisolone appeared is higher than those using hydrocortisone in patients with primary adrenal insufficiency. The mechanisms of this difference may be patient and care mechanism related.