Once daily low dose prednisolone vs. hydrocortisone in treating adrenal insufficiency (HYPER-AID Study)

Kushalee Jayawickreme; Charles Antonypillai; Sanas Mohamed; Bhagya Dharmasiri; Nishan Ravindu; Jeewashini Ratnayake; Fathima Nazeeha; Karim Meeran

doi:10.1530/endoabs.109.P46

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Endocrine Abstracts (2025) 109 P46 | DOI: 10.1530/endoabs.109.P46

SFEBES2025 Poster Presentations Adrenal and Cardiovascular (61 abstracts)

Once daily low dose prednisolone vs. hydrocortisone in treating adrenal insufficiency (HYPER-AID Study)

Kushalee Jayawickreme ¹ , Charles Antonypillai ¹ , Sanas Mohamed ² , Bhagya Dharmasiri ¹ , Nishan Ravindu ¹ , Jeewashini Ratnayake ¹ , Fathima Nazeeha ¹ & Karim Meeran ³

Author affiliations

¹National Hospital Kandy, Kandy, Sri Lanka; ²Lister Hospital, East and North Hertfordshire NHS Trust, East and North Hertfordshire, United Kingdom; ³Imperial College London, London, United Kingdom

Background: Low dose once daily prednisolone is an easier and cheaper steroid option than multiple dose hydrocortisone. Prednisolone is noted to be seven times more potent than hydrocortisone.

Methods: A cross-over study of patients with adrenal insufficiency (AI) treated at the National Hospital Kandy, Sri Lanka were switched over from hydrocortisone to equivalent doses of low dose Prednisolone (3.75 – 5 mg). An analysis was performed comparing means of outcomes by the paired t-test.

Results: 117 patients were recruited and 101 continued Prednisolone for the study period, while 6 lost to follow up and 9 switched back to hydrocortisone within 2 to 8 weeks of changing to prednisolone. 89 were on 3.75 mg prednisolone and 12 on 5 mg daily. Male:female ratio was 1.19:1 and mean age was 48.4 years (SD=16.7). 76 and 25 patients had secondary (pituitary) and primary AI respectively. Those with primary AI were administered Fludrocortisone in addition to Prednisolone. There was no difference in weight, BMI and waist:hip ratio (P = 0.059) while on either of the drugs. Mean HDL was higher on prednisolone than on hydrocortisone being 54.7 mg/dl vs 51.3 mg/dl respectively (P = 0.017). Total cholesterol, LDL, triglyceride levels were non-significantly lower on prednisolone compared to on hydrocortisone. Mean HbA1c on hydrocortisone was 6.5% and 6.3% on prednisolone (P = 0.2). ALT (P = 0.005) and AST (P = 0.011) were lower on prednisolone than on hydrocortisone. There was no significant difference on sodium, potassium, creatinine and bilirubin level. There was no difference in quality of life assessed by the separate SF36 9 domains while on either prednisolone or hydrocortisone. There was no difference in outcomes if prednisolone was used in primary or secondary AI.

Conclusion: Once daily Prednisolone is a non-inferior alternative to multiple dose hydrocortisone in treating primary and secondary AI and has metabolic benefits.