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Modified-release Hydrocortisone in Congenital Adrenal Hyperplasia

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  • Deborah P Merke
  • Ashwini Mallappa
  • Wiebke Arlt
  • Aude Brac de la Perriere
  • Angelica Lindén Hirschberg
  • Anders Juul
  • John Newell-Price
  • Colin G Perry
  • Alessandro Prete
  • D Aled Rees
  • Nicole Reisch
  • Nike Stikkelbroeck
  • Phillippe Tourraine
  • Kerry Maltby
  • F Peter Treasure
  • John Porter
  • Richard J Ross
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CONTEXT: Standard glucocorticoid therapy in congenital adrenal hyperplasia (CAH) regularly fails to control androgen excess, causing glucocorticoid overexposure and poor health outcomes.

OBJECTIVE: We investigated whether modified-release hydrocortisone (MR-HC), which mimics physiologic cortisol secretion, could improve disease control.

METHODS: A 6-month, randomized, phase 3 study was conducted of MR-HC vs standard glucocorticoid, followed by a single-arm MR-HC extension study. Primary outcomes were change in 24-hour SD score (SDS) of androgen precursor 17-hydroxyprogesterone (17OHP) for phase 3, and efficacy, safety and tolerability of MR-HC for the extension study.

RESULTS: The phase 3 study recruited 122 adult CAH patients. Although the study failed its primary outcome at 6 months, there was evidence of better biochemical control on MR-HC, with lower 17OHP SDS at 4 (P = .007) and 12 (P = .019) weeks, and between 07:00h to 15:00h (P = .044) at 6 months. The percentage of patients with controlled 09:00h serum 17OHP (< 1200 ng/dL) was 52% at baseline, at 6 months 91% for MR-HC and 71% for standard therapy (P = .002), and 80% for MR-HC at 18 months' extension. The median daily hydrocortisone dose was 25 mg at baseline, at 6 months 31 mg for standard therapy, and 30 mg for MR-HC, and after 18 months 20 mg MR-HC. Three adrenal crises occurred in phase 3, none on MR-HC and 4 in the extension study. MR-HC resulted in patient-reported benefit including menses restoration in 8 patients (1 on standard therapy), and 3 patient and 4 partner pregnancies (none on standard therapy).

CONCLUSION: MR-HC improved biochemical disease control in adults with reduction in steroid dose over time and patient-reported benefit.

Original languageEnglish
JournalThe Journal of clinical endocrinology and metabolism
Volume106
Issue number5
Pages (from-to)e2063-e2077
ISSN0021-972X
DOIs
Publication statusPublished - May 2021

    Research areas

  • 21-hydroxylase deficiency, adrenal insufficiency, congenital adrenal hyperplasia, glucocorticoid, hydrocortisone

ID: 63790286