This article is more than 5 years old. Information may no longer be current.
Patients report nonadherence, fear of adverse effects with glucocorticoid therapy
Click Here to Manage Email Alerts
Most adults prescribed glucocorticoid therapy for adrenal insufficiency reported some form of nonadherence to treatment, with many voicing fears of weight gain, osteoporosis and continued risk for adrenal crisis, according to research in Clinical Endocrinology.
In a cross-sectional survey of patients in five European countries, patients also reported dissatisfaction with information they received regarding potential adverse events that may result from glucocorticoid therapy.
“Nonadherence to [glucocorticoid therapy] may place participants at risk for avoidable morbidity and mortality,” Sarah Chapman, MSc, DPhil, an excellence fellow in behavioral medicine at University College London, and colleagues wrote. “Under-replacing hydrocortisone can lead to potentially fatal adrenal crises, whereas over-replacing hydrocortisone can lead to Cushing’s-like symptoms.”
Chapman and colleagues analyzed data from 81 adults (mean age, 47 years; 68% women) prescribed glucocorticoid therapy for either Addison’s disease, secondary adrenal insufficiency or congenital adrenal hyperplasia from the United Kingdom (n = 20), Germany (n = 10), Sweden (n = 15), France (n = 20) and Spain (n = 16). Participants completed an online survey, answering questions about medication adherence using the Medication Adherence Report Scale, their personal views about the need for glucocorticoid therapy using the Beliefs about Medicines Questionnaire (adapted for adrenal insufficiency) and their satisfaction about information they received about therapy using the Satisfaction with Information about Medicines Scale. Patients were paid for completing the survey.
Most participants (79%) reported being diagnosed with Addison’s disease or congenital adrenal hyperplasia, with a mean time since diagnosis of 12.2 years; 22% reported at least one hospital admission for adrenal crisis within the past 12 months; 51.9% reported missing at least 1 day from work or school due to illness. Most participants reported taking hydrocortisone tablets either twice daily (45.7%) or three times daily (37%).
Within the cohort, 14.8% of the participants reported full adherence to glucocorticoid therapy, whereas 34.6% were classified as “low adherence,” and 65.4% were classified as “high adherence.” Nonadherence was due to both dose and timing; 79% reported any dose nonadherence, and 66.7% reported any timing nonadherence; 37% reported taking their dose later in the day than advised; 34.6% reported taking their dose at a different time of day than advised. Women were more likely to report nonadherence than men (41.8% vs. 19.2%; P = .05).
Most participants reported that they understood their need for glucocorticoid therapy; however, more than half reported concerns regarding possible long-term adverse effects from medication, including osteoporosis (53.1%), weight gain (50.6%) and adrenal crisis despite medication (50.6%). In addition, 61.7% of participants reported that they were dissatisfied with the amount of information they received regarding potential adverse events that may result from glucocorticoid therapy and what they should do if they experience unwanted adverse effects. – by Regina Schaffer
Disclosure: One of the study researchers is a founder and director of Spoonful of Sugar Ltd., a health care and pharmaceutical consulting company through University College London School of Business. The study was funded by ViroPharma through a commercial contract with Spoonful of Sugar.
Perspective
Back to TopDeborah P. Merke, MD, MS
As clinicians, we are aware of the fact that the glucocorticoid regimens used to treat adrenal insufficiency are suboptimal. This recognition has led to studies of novel treatment approaches, some aimed at replacing cortisol in a near physiologic manner. The study by Chapman and colleagues emphasizes an important aspect of patient outcome that is often overlooked — patient adherence. A remarkable 85% of patients with adrenal insufficiency in this new study reported some degree of nonadherence to their glucocorticoid regimen. Most importantly, their nonadherence was related to fear about adverse side effects and dissatisfaction with patient education. Although the population studied may have been biased (patients with complaints are more likely to respond to a survey), this study reminds us of William Osler’s famous quote, “The good physician treats the disease; the great physician treats the patient who has the disease.” Clearly, not only are new ways of replacing cortisol needed, but improvement in patient (and physician) education is also essential to optimize patient outcome.
Click Here to Manage Email Alerts