Hormone Replacement Therapy with Prednisolone Is Associated with a Worse Lipid Profile Than with Hydrocortisone in Patients with Adrenal Insufficiency

Presentation Number: OR03-5
Date of Presentation: April 2nd, 2017

Robert D. Murray*1, Bertil Ekman2, Claudio Marelli3, Sharif Uddin4, Pierre M J Zelissen5 and Marcus Quinkler6
1Leeds Teaching Hospitals NHS Trust, St James’s University Hospital, Leeds, United Kingdom, 2Linköping University, Linköping, Sweden, 3Shire International GmbH, Zug, Switzerland, 4Shire, Lexington, MA, 5University Medical Center Utrecht, Utrecht, Netherlands, 6Endocrinology in Charlottenburg, Berlin, Germany

Abstract

Prednisolone is used as glucocorticoid replacement therapy for patients with adrenal insufficiency (AI). Recent data indicate that the use of prednisolone in AI is associated with low bone mineral density. Data on risk factors for cardiovascular disease in patients with AI treated with prednisolone are scarce, despite this condition being the predominant cause of excess mortality. We aimed to address this gap in the literature using real-world data from the European Adrenal Insufficiency Registry (EU-AIR). EU-AIR is a prospective, observational study, initiated in August 2012 to monitor the long-term safety of glucocorticoids in patients with AI. Patients were recruited from 19 centres across Germany, the Netherlands, Sweden and the UK. For this analysis, patients receiving prednisolone (3–6 mg/day, n = 50) or hydrocortisone (15–30 mg/day, n = 909) were identified and grouped in a ratio of 1:3 (prednisolone:hydrocortisone) by matching for sex, age, duration and type of disease. Data from baseline and 1-year follow-up visits were analysed. Data from patients with congenital adrenal hyperplasia were excluded.

We report significantly higher mean ± standard deviation total cholesterol (6.3 ± 1.6 vs 5.4 ± 1.1 mmol/l; P = 0.003) and low density lipoprotein (LDL) cholesterol levels (3.9 ± 1.4 vs 3.2 ± 1.0 mmol/l; P = 0.013) in 47 patients on prednisolone versus 141 receiving hydrocortisone at baseline and at follow-up (P = 0.005 and P = 0.006, respectively). HbA1c, high density lipoprotein cholesterol and triglyceride levels, body mass index, systolic and diastolic blood pressure and waist circumference did not differ significantly between groups. The proportions of patients receiving statins did not differ significantly between groups.

Based on this first of its kind matched analysis, we conclude that significantly higher LDL levels in patients receiving prednisolone relative to hydrocortisone could predict a higher relative risk of cardiovascular disease in the former group.

 

Disclosure: RDM: Consultant, Shire, Speaker, Shire. BE: Speaker, Shire, Consultant, Shire. CM: Employee, Shire. SU: Employee, Shire. PMJZ: Consultant, Shire, Speaker, Shire. MQ: Consultant, Shire, Speaker, Shire.