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Cited by 8Adrenal Hormones and DisordersHormonal and reproductive studiesStress Responses and Cortisol

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 A., Gallacher, Daniel, Hanson, Petra, Randeva, Harpal S., Weickert, Martin O., Barber, Thomas M.·2020·Clinical Endocrinology
DOI 10.1111/cen.14275
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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. Randomized 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 (−0.82 kg; 95% CI: −1.24 kg to −0.40 kg; P < .001) and HbA1c (−0.13%; 95% CI: −0.214% to −0.045%; P = .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 < .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.

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Crossref · 10.1111/cen.14275

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  • Modified-release hydrocortisone is associated with an improved lipid profile.

    “Studies have reported a significant reduction in body mass index, improved lipid profile, better glycaemic control and improved quality of life in those who are in the MR-HC group (58, 59).”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [58]

    The Discussion (page not available in our copy) reports lower total cholesterol in longer-term nonrandomised studies and lower LDL cholesterol in one study, offering some support for improved lipids. But the RCT meta-analysis found no significant change in total or LDL cholesterol, while HDL fell and triglycerides rose at three months. The source therefore does not support an unqualified improvement in lipid profile. (LLM, conf=0.86)

    Experimental — accuracy not yet measured

  • Modified-release hydrocortisone is associated with better glycaemic control.

    “Studies have reported a significant reduction in body mass index, improved lipid profile, better glycaemic control and improved quality of life in those who are in the MR-HC group (58, 59).”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [58]

  • Modified-release hydrocortisone is associated with a significant reduction in body mass index.

    “Studies have reported a significant reduction in body mass index, improved lipid profile, better glycaemic control and improved quality of life in those who are in the MR-HC group (58, 59).”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [58]

  • Modified-release hydrocortisone is associated with improved quality of life.

    “Studies have reported a significant reduction in body mass index, improved lipid profile, better glycaemic control and improved quality of life in those who are in the MR-HC group (58, 59).”

    From Hypoglycaemia in adrenal insufficiency (2023) · cites this paper as [58]

    The Discussion (page unavailable) reports improvements in metabolic outcomes after switching to modified-release hydrocortisone, but does not report a quality-of-life finding. Searches for “quality of life,” “health-related quality of life,” and “QoL” found those terms in reference titles, not in the review’s reported findings. (LLM, conf=0.69)

    Experimental — accuracy not yet measured

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Cites

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Cited by

Sorted by citations

Authors
Bannon, C. A., Gallacher, D., Hanson, P., Randeva, H. S., Weickert, M. O., & Barber, T. M.
Affiliations
  • University Hospital Coventry (GB)
  • University of Warwick (GB)
Corresponding author
Bannon, Christopher A.
ORCID
Venue
Clinical Endocrinology
Publisher
Wiley
Published
2020-08-08
Volume
93
Issue
6
Pages
637-651
ISSN
  • 0300-0664 (ISSN-L)
  • 1365-2265
DOI
10.1111/cen.14275
OpenAlex
W3039077304
Cited by
8
References
6
Citations by year
2026: 1 · 2023: 3 · 2022: 1 · 2021: 2 · 2020: 1
FWCI
0.27
Type
journal article
Language
en
Open access
Licence
onlinelibrary.wiley.com/termsAndConditions#vor (vor)
Locations
  • Clinical Endocrinology (publishedVersion)
  • PubMed (publishedVersion)
  • Warwick Research Archive Portal (University of Warwick) (acceptedVersion)
Funders
National Institute for Health and Care Research (ACF-2017-08-001)
Topics
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Adrenal Hormones and Disorders
  • Health Sciences › Medicine › Endocrinology, Diabetes and Metabolism › Hormonal and reproductive studies
  • Life Sciences › Neuroscience › Behavioral Neuroscience › Stress Responses and Cortisol
Keywords
adrenal insufficiency, cortisol, modified-release hydrocortisone, glucocorticoid replacement therapy, metabolic effects, body weight, HbA1c, glucose metabolism, diabetes mellitus, anthropometric measures, lipid profile
MeSH terms
Adrenal Insufficiency, Adult, Body Weight, Glucocorticoids, Humans, Hydrocortisone, Hormone Replacement Therapy

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