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Adrenal insufficiency requires improved management, alternative therapy
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Patients receiving conventional immediate-release oral hydrocortisone replacement therapy for treatment of adrenal insufficiency report a compromised quality of life and significant changes in work, social life and physical activity, according to data presented at the 15th European NeuroEndocrine Association Congress in Vienna.
Although conventional immediate-release oral hydrocortisone replacement therapy has been the gold standard of care for adrenal insufficiency for more than 50 years, researchers said their current survey demonstrates that patients with this disorder require improved management of their condition, as well as alternatives to standard glucocorticoid replacement therapy. This is especially evident in patients with secondary adrenal insufficiency, they said in a press release.
“Hydrocortisone replacement therapy should replace the body’s natural, daily production of cortisol and mimic its diurnal variation, but immediate-release conventional therapy cannot fully mimic the body in this respect, despite multiple dosing throughout the day,” Gudmundur Johannsson, MD, PhD, senior consultant in the department of endocrinology at Sahlgrenska University Hospital, and professor of endocrinology at Sahlgrenska Academy at the University of Gothenburg in Sweden, said in a press release.
Johannsson and colleagues conducted a worldwide survey of 1,245 patients who were recruited through patient organizations. According to results, 87% of patients with secondary adrenal insufficiency and 60% of those with primary adrenal insufficiency reported that their condition affects quality of life.
Compared with patients with primary adrenal insufficiency, those with secondary adrenal insufficiency reported that fatigue had a larger effect on daily activities, including work life (44% vs. 58%), social life (51% vs. 71%), physical activity (70% vs. 80%) and family life (39% vs. 64%).
“As a result of unsatisfactory [adrenal insufficiency] management, patients have an increased morbidity and a two- to threefold increase in mortality compared to the background population,” Johannsson said. “Four out of 10 [adrenal insufficiency] patients reported issues with multiple daily dosing regimens, which can result in compliance problems. It is therefore not surprising that this survey reveals a significant number of patients who are suggesting a need for improvement in their replacement therapy.”
The survey was designed to document current practice in glucocorticoid replacement therapy and to determine self-perceived health status and outcomes, according to the press release.
Additional findings demonstrated that 20% of patients with secondary adrenal insufficiency required dosing adjustment to counteract morning or daytime fatigue vs. 16% of patients with primary adrenal insufficiency. Furthermore, 39% of patients with secondary adrenal insufficiency reported they were fit enough to work vs. 65% of those with primary adrenal insufficiency. Of these, 59% and 74% reported full-time employment.
Disclosure: The survey was made possible through funding from DuoCort Pharma, a wholly owned subsidiary of ViroPharma Inc.