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. 2017 Nov;6(8):766-772.
doi: 10.1530/EC-17-0257. Epub 2017 Oct 10.

Prednisolone has the same cardiovascular risk profile as hydrocortisone in glucocorticoid replacement

David J F Smith  1 , Hemanth Prabhudev  1 , Sirazum Choudhury  1   2   3 , Karim Meeran  4   3
Affiliations

Prednisolone has the same cardiovascular risk profile as hydrocortisone in glucocorticoid replacement

David J F Smith et al. Endocr Connect. 2017 Nov.

Abstract

Introduction: Patients who need glucocorticoid replacement in both primary and secondary adrenal insufficiency (AI) have the choice of either once-daily prednisolone or thrice-daily hydrocortisone. A recent European study found no difference between prednisolone and hydrocortisone users in several markers including glucose, weight, body mass index, systolic and diastolic blood pressure and waist circumference, although an increase in cholesterol and low-density lipoprotein (LDL) was suggested in a subgroup of these patients. The aim of this study was to expand the evidence base for the use of these agents as replacement therapy.

Methods: Data from 82 patients on hydrocortisone and 64 patients on prednisolone for AI at Imperial College Healthcare NHS Trust were analysed.

Results: There was no significant difference in total cholesterol, LDL levels or any other risk factors between hydrocortisone and prednisolone patients. Prednisolone was subjectively significantly more convenient than hydrocortisone (P = 0.048).

Conclusions: Prednisolone once daily is more convenient than hydrocortisone thrice daily, and there is no difference in the markers of cardiovascular risk measured. Because prednisolone mimics the circadian rhythm better than other glucocorticoids, it should be considered as an alternative to hydrocortisone for AI.

Keywords: adrenal insufficiency; cardiovascular risk; hydrocortisone; prednisolone.

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Figures

Figure 1
Figure 1
Frequency of the daily doses of replacement therapy taken by patients. (A) Total daily hydrocortisone dose by patients with primary and secondary AIs. (B) Daily dose of prednisolone taken by patients with primary and secondary AIs.
Figure 2
Figure 2
Biochemical structure of aldosterone, fludrocortisone, cortisol and prednisolone. The changes that give a longer half-life are shown in red. A fluorine atom is present in fludrocortisone, and a double bond in prednisolone is the only difference between these molecules and cortisol.
See this image and copyright information in PMC

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