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Systematic review and meta-analysis of the metabolic effects of modified-release hydrocortisone versus standard glucocorticoid replacement therapy in adults with adrenal insufficiency
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Bannon, Christopher, Gallacher, Daniel C., Hanson, Petra, Randeva, Harpal S., Weickert , Martin and Barber, Thomas M. (2020) Systematic review and meta-analysis of the metabolic effects of modified-release hydrocortisone versus standard glucocorticoid replacement therapy in adults with adrenal insufficiency. Clinical Endocrinology, 93 (6). pp. 637-651. doi:10.1111/cen.14275
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WRAP-Systematic-review-meta-release-hydrocortisone-glucocorticoid-replacement-therapy-adrenal-insufficiency-Barber-2020.pdf - Accepted Version - Requires a PDF viewer. Download (1428Kb) | Preview |
Official URL: https://doi.org/10.1111/cen.14275
Abstract
Context
Published studies exploring the metabolic effects of Modified‐Release Hydrocortisone (MR‐HC) replacement in patients with adrenal insufficiency (AI).
Objective
To compare metabolic effects of MR‐HC with Standard Glucocorticoid (SG) replacement in adults with AI. Randomised control trials (RCTs) were meta‐analysed; non‐RCT studies described narratively with critical appraisal.
Data sources
PubMed/Medline, EMBASE, CINAHL and CENTRAL were searched to identify relevant articles, published before Aug 2019.
Study selection
All study types that reported metabolic profile (including anthropometric, glucose and lipid‐related parameters), on patients switched from SG to MR‐HC replacement. Following independent screening from two reviewers, 390 studies were identified, of which 9 studies were included for review (RCT, n=2; non‐RCT, n=7).
Data extraction
Two independent reviewers assessed each paper for bias and data extraction.
Results
Meta‐analysis from RCTs (n=2), 104 patients were switched from SG to MR‐HC replacement. Combining treatment effects, at 3‐months post‐therapy switch there was significant reduction in body weight (‐0.82kg; 95% CI: ‐1.24kg to ‐0.40kg; p<0.001) and HbA1c (‐0.13%; 95% CI: ‐0.214% to ‐0.045%; p=0.003). In the sub‐group with Diabetes Mellitus (DM), reduction in HbA1C was more pronounced (‐0.52%; 95% CI: ‐0.82% to ‐0.23%; p<0.001). Non‐RCT studies showed improved anthropometric measures and glucose metabolism up to 48‐months following switch from SG to MR‐HC replacement.
Conclusions
In adults with AI, replacement with MR‐HC associates with significant improvements in anthropometric measurements and HbA1c compared with SG replacement, particularly those with DM.
| Item Type: | Journal Article | ||||||||
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| Subjects: | Q Science > QP Physiology R Medicine > RC Internal medicine R Medicine > RM Therapeutics. Pharmacology |
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| Divisions: | Faculty of Medicine > Warwick Medical School > Biomedical Sciences Faculty of Medicine > Warwick Medical School > Biomedical Sciences > Translational & Experimental Medicine > Metabolic and Vascular Health (- until July 2016) Faculty of Medicine > Warwick Medical School |
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| Library of Congress Subject Headings (LCSH): | Adrenal glands -- Diseases, Hydrocortisone -- Therapeutic use, Glucocorticoids -- Receptors, Metabolism -- Regulation, Glucocorticoids -- Therapeutic use | ||||||||
| Journal or Publication Title: | Clinical Endocrinology | ||||||||
| Publisher: | Wiley-Blackwell Publishing Ltd | ||||||||
| ISSN: | 0300-0664 | ||||||||
| Official Date: | December 2020 | ||||||||
| Dates: |
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| Volume: | 93 | ||||||||
| Number: | 6 | ||||||||
| Page Range: | pp. 637-651 | ||||||||
| DOI: | 10.1111/cen.14275 | ||||||||
| Status: | Peer Reviewed | ||||||||
| Publication Status: | Published | ||||||||
| Publisher Statement: | "This is the peer reviewed version of the following article:Bannon, C., Gallacher, D., Hanson, P., Randeva, H., Weickert, M. and Barber, T. (2020), Systematic Review and Meta‐Analysis of the Metabolic Effects of Modified‐Release Hydrocortisone versus Standard Glucocorticoid Replacement Therapy in Adults with Adrenal Insufficiency. Clin Endocrinol. Accepted Author Manuscript. doi:10.1111/cen.14275, which has been published in final form at https://doi.org/10.1111/cen.14275. This article may be used for non-commercial purposes in accordance with Wiley Terms and Conditions for Use of Self-Archived Versions." | ||||||||
| Access rights to Published version: | Restricted or Subscription Access | ||||||||
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