Objective:

To compare the cardiometabolic and bone turnover effects of once-daily low-dose prednisolone versus thrice-daily hydrocortisone in patients with adrenal insufficiency, emphasizing the comparative aspect.

Key Findings:

• Bone turnover was significantly slower during prednisolone treatment, with lower levels of specific bone markers compared to hydrocortisone.
• Patients on prednisolone experienced greater reductions in body weight, BMI, waist circumference, and glycated hemoglobin.

Interpretation:

While prednisolone showed modest cardiometabolic benefits and slower bone turnover, the clinical significance of these findings is uncertain and requires further investigation, particularly regarding implications for treatment guidelines.

Limitations:

• Findings are based on surrogate markers; longer-term studies are needed.
• Magnitude of change in bone markers was small compared to antiresorptive therapies, and future studies should include more diverse patient populations.

Conclusion:

Prednisolone may be a viable alternative to hydrocortisone for adrenal insufficiency, but further research is needed to confirm clinical outcomes and their significance.

Sources:

• JAMA Network Open