Chronic glucocorticoid therapy tied to dose-dependent adrenal risk

  • Mebrahtu TF & al.
  • J Clin Endocrinol Metab
  • 22 Apr 2019

  • International Clinical Digest
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Takeaway

  • Oral glucocorticoid treatment for chronic inflammatory disease is associated in a dose-dependent manner with adrenal insufficiency and Cushing’s syndrome.

Why this matters

  • Glucocorticoids have previously been linked to adrenal risk and mortality, but this study provides population data showing a dose-dependent effect.

Key results

  • During a median follow-up of 5.5 years, 0.3% of patients were diagnosed with adrenal insufficiency (overall incidence rate, 0.41 per 1000 person-years).
  • Risk for adrenal insufficiency was higher with increased daily dose (aHR, 1.07; 95% CI, 1.04-1.09 per 5 mg) and cumulative dose (aHR, 1.09; 95% CI, 1.08-1.10 per 1000 mg) of glucocorticoid.
  • 0.4% of patients were diagnosed with Cushing’s syndrome (overall incidence rate, 0.55 per 1000 person-years).
  • Risk for Cushing’s syndrome was higher with increased daily dose (aHR, 1.09; 95% CI, 1.08-1.11 per 5 mg) and cumulative dose (aHR, 1.10; 95% CI, 1.08-1.11 per 1000 mg) of glucocorticoid.
  • Risk for mortality was higher with increased daily dose (aHR, 1.06; 95% CI, 1.05-1.06) and cumulative dose (aHR, 1.03; 95% CI, 1.03-1.04 per 1000 mg).

Study design

  • 70,638 subjects treated with oral glucocorticoids and 41,166 nonusers were analyzed for adrenal dysfunction and death rates.
  • Funding: Medical Research Council; European Research Council; National Institute for Health Research.

Limitations

  • Retrospective study of large database.